Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block

Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block: a wasted effort

“…In our study, as in others [10], QRS duration > 155 msec, predicted left ventricular hypertrophy ryi 220 in a good proportion of patients (positive predictive value : 88Vo). We had better results with some voltage criteria (Table 2).…”

“…Se";eral studies have demonstrated that anatomic lefr ventricular hypertrophy is a common findtng i;, patients with left bundle branch block, but n C"t respondence to: Pietîo Vincenzo Fragola, M.D., Via A. disagreement exists as to whether or not the electrocardiogram can be applied for diagnosing left ventricular hypertrophy in these instances [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

“…The variable results may also reflect differing definitions of LBBB. Strict definitions, which require monophasic notched or plateau-topped R waves in leads I, aVL, V 5 , and V 6 , tend to show low sensitivity for LVH criteria (42). Broader definitions, which require only a QRS duration greater than 120 ms, slurred predominant R in left precordial leads, and slurred predominant S wave in the right precordial leads, probably include cases that could be classified as LVH with associated intraventricular conduction delay rather than LBBB.…”

AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

“…Strict definitions, which require monophasic notched or plateautopped R waves in leads I, aVL, V 5 , and V 6 , tend to show low sensitivity for LVH criteria. 42 Broader definitions, which require only a QRS duration greater than 120 ms, slurred predominant R in left precordial leads, and slurred predominant S wave in the right precordial leads, probably include cases that could be classified as LVH with associated intraventricular conduction delay rather than LBBB. Because "complete" LBBB may often be not truly complete, and because the QRS duration in LVH can probably be greater than 120 ms without a localized lesion in the left bundle, the distinction between these two entities may be difficult to define.…”