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Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations.

Publication ,  Journal Article
Galeotti, L; van Dam, PM; Loring, Z; Chan, D; Strauss, DG
Published in: Europace
December 2013

AIMS: Left bundle branch block (LBBB) is a critical predictor of patient benefit from cardiac resynchronization therapy (CRT), but recent studies suggest that one-third of patients diagnosed with LBBB by conventional electrocardiographic (ECG) criteria may have a false-positive diagnosis. In this study, we tested the hypothesis that recently proposed strict LBBB ECG criteria improve specificity in cases of left ventricular hypertrophy (LVH) /dilatation and incomplete LBBB. METHODS AND RESULTS: We developed five heart models based on a healthy male with increasing degrees of LV hypertrophy and/or dilation. With each model, we simulated six conduction types: normal conduction, four increments of delayed initiation of LV activation (incomplete LBBB), and complete LBBB. Simulated ECGs were evaluated for the presence of LBBB by conventional (LV conduction delay and QRSd ≥120 ms) and strict ECG criteria (LV conduction delay, QRSd ≥140 ms men or ≥130 ms women, and mid-QRS notching in at least two of the leads I, aVL, V1, V2, V5, and/or V6). Both conventional and strict LBBB criteria had 100% sensitivity. However, conventional criteria falsely diagnosed LBBB in cases with LVH + LV dilated 10 mm, LVH or LV dilated 10 mm combined with LV initiation ≥6 ms after the right ventricle (RV), and with LV dilated 5 mm combined with LV initiation ≥12 ms after RV (48% specificity). Strict LBBB criteria resulted in no false positives (100% specificity). CONCLUSIONS: New strict LBBB criteria increase the specificity of complete LBBB diagnosis in the presence of LV hypertrophy/dilatation and incomplete LBBB, which is critical for selecting CRT patients.

Duke Scholars

Published In

Europace

DOI

EISSN

1532-2092

Publication Date

December 2013

Volume

15

Issue

12

Start / End Page

1816 / 1821

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Prognosis
  • Predictive Value of Tests
  • Patient Selection
  • Models, Cardiovascular
  • Male
  • Magnetic Resonance Imaging
  • Hypertrophy, Left Ventricular
  • Humans
  • Heart Failure
 

Citation

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Galeotti, L., van Dam, P. M., Loring, Z., Chan, D., & Strauss, D. G. (2013). Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace, 15(12), 1816–1821. https://doi.org/10.1093/europace/eut132
Galeotti, Loriano, Peter M. van Dam, Zak Loring, Dulciana Chan, and David G. Strauss. “Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations.Europace 15, no. 12 (December 2013): 1816–21. https://doi.org/10.1093/europace/eut132.
Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG. Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace. 2013 Dec;15(12):1816–21.
Galeotti, Loriano, et al. “Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations.Europace, vol. 15, no. 12, Dec. 2013, pp. 1816–21. Pubmed, doi:10.1093/europace/eut132.
Galeotti L, van Dam PM, Loring Z, Chan D, Strauss DG. Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations. Europace. 2013 Dec;15(12):1816–1821.
Journal cover image

Published In

Europace

DOI

EISSN

1532-2092

Publication Date

December 2013

Volume

15

Issue

12

Start / End Page

1816 / 1821

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Prognosis
  • Predictive Value of Tests
  • Patient Selection
  • Models, Cardiovascular
  • Male
  • Magnetic Resonance Imaging
  • Hypertrophy, Left Ventricular
  • Humans
  • Heart Failure