The relationship between mitral papillary muscles positions and characteristics of the QRS complex

Hakacova, Nina; Robinson, Anna M.C.; Olson, Charles W.; Selvester, Ronald H.; Wagner, Galen S.

doi:10.1016/j.jelectrocard.2008.07.025

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…The latter could be caused by changes of the normal sequence of LV myocardial activation produced by changes in the sites of the junctions of the LBB fascicles on the LV endocardium. A relationship between the PM positions and the QRS complex characteristics has been recently described in healthy subjects (6). It was suggested that an individual's PM positions can serve as a marker of the borders of the endocardial area directly supplied by the left fascicles.…”

Section: Discussionmentioning

confidence: 96%

“…From the perspective of electrical activation, left deviation of the QRS axis (LAD) in the frontal plane is frequently present and suggests an alteration in the electrical activation sequence of the left ventricle (LV) (2)(3)(4)(5). Understanding the electroanatomic relationships in the heart is essential for appropriate diagnosis and management of heart conditions and for shedding light on the developmental relationships between the conduction system and heart structures (6,7). Papillary muscles (PMs), as part of the atrioventricular valve complex, have recently been studied in relation to the variability of QRS complex characteristics in healthy individuals (6).…”

mentioning

confidence: 99%

“…Understanding the electroanatomic relationships in the heart is essential for appropriate diagnosis and management of heart conditions and for shedding light on the developmental relationships between the conduction system and heart structures (6,7). Papillary muscles (PMs), as part of the atrioventricular valve complex, have recently been studied in relation to the variability of QRS complex characteristics in healthy individuals (6). The findings suggest that variations of the QRS axis are caused by variations in the location of the Purkinje conduction system (specifically left bundle branch [LBB] fascicles), as indicated by the locations of the respective LV PMs, toward which the borders of the fan-like fascicles course.…”

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confidence: 99%

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Electroanatomic Relationships in Patients With Primum Atrioventricular Septal Defect

Hakacova

Wagner

Idriss

2009

JACC: Cardiovascular Imaging

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Abnormality in the position of the papillary muscles changes continuously with the abnormality of the QRS axis. Understanding the electroanatomic relationships provides important insight into developmental relationships between the conduction system and the trabecular structures in primum AVSD patients. These results may provide insights in understanding the continuity of primum AVSD abnormality, in estimating the best surgical approach, and predicting the prognosis of primum AVSD patients.

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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Electroanatomic Relationships in Patients With Primum Atrioventricular Septal Defect

Hakacova

Wagner

Idriss

2009

JACC: Cardiovascular Imaging

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“…10 Of these 16 subjects, 12 were included in this study. 2 were excluded for presence of left ventricular hypertrophy and 2 were excluded for missing ECG or MRI data.…”

Section: Methodsmentioning

confidence: 99%

Modeling vectorcardiograms based on left ventricle papillary muscle position

Loring¹,

Olson²,

Maynard³

et al. 2011

Journal of Electrocardiology

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Background Vectorcardiographic QRS loops illustrate the electrical activation of the left ventricle (LV) in three dimensional space; however, the individual variability in these loops is not well understood. The left bundle branch fan distributes the initial activation to the LV and has been shown to distribute its fascicles between the LV papillary muscles. Computer models of LV activation utilizing papillary muscle as the initial electrical activation points accurately predict QRS duration and frontal plane axis. Methods 12 healthy adults received standard 12-lead ECGs and 1.5 T cardiac MRI. Software developed by ECG-TECH Corp generated 3 dimensional QRS vector loops for each subject. Short and long axis papillary muscle positions were measured for each subject using cardiac MRI images. A theoretical plane equidistant from the endocardial origins of each papillary muscle was constructed. Vectors perpendicular to the QRS vector loop and the theoretical plane termed the “plane identifier” were used for comparison. Spearman-rank correlation was used to compare the azimuth and elevation of the “plane identifiers” of the QRS vector loop and the theoretical plane. Results No correlation was found between the azimuth or elevation of the theoretical plane and the QRS vector loops with Spearman-rank correlation coefficients of ρ = 0.11 (p=0.71) and ρ = 0.22 (p=0.49) respectively. Subgroup analysis by QRS vector loop morphology (planar vs. non-planar; narrow vs. wide) also demonstrated no correlation. Conclusions Modeling the activation of the LV based on papillary muscle position alone may be overly simplistic. Better understanding of what other factors contribute to individual variation in LV activation will help develop a more useful theoretical model.

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“…Clinically, prolonged QRS duration and increased amplitude (voltage) are interpreted as signs of slow depolarization of an enlarged left ventricle (LV) and the prolonged activation of thickened ventricular wall, respectively . The effect of LV size on QRS morphology is normally affected by gender, cavity geometry, and myocardial fiber orientation, as well as pathologically by ischemic heart disease, cardiomyopathies, myocardial fibrosis and pulmonary diseases . However, the diagnostic concordance between QRS morphology and echocardiographic or magnetic resonance estimation of LV mass and volume is limited and the direct association between changes in QRS amplitude and LV size remains controversial …”

Section: Introductionmentioning

confidence: 99%

Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals

Vancheri¹,

Vancheri²,

Henein

2017

Echocardiography

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The relationship between mitral papillary muscles positions and characteristics of the QRS complex

Cited by 15 publications

References 16 publications

Electroanatomic Relationships in Patients With Primum Atrioventricular Septal Defect

Electroanatomic Relationships in Patients With Primum Atrioventricular Septal Defect

Modeling vectorcardiograms based on left ventricle papillary muscle position

Relationship between QRS measurements and left ventricular morphology and function in asymptomatic individuals

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