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Left bundle branch block and right axis deviation: a report of 36 cases
R Childers1, S Lupovich, M Sochanski
1University of Chicago Medical Centre, IL 60637, USA.
Journal of Electrocardiology
|March 27, 2001
Summary
Right axis deviation (RAD) with left bundle branch block (LBBB) is a rare finding. This study identified 36 patients, mostly with dilated cardiomyopathy, and explored the variable nature of RAD and LBBB.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Right axis deviation (RAD) and left bundle branch block (LBBB) are uncommon co-occurring electrocardiogram findings.
- The clinical significance and presentation of this combined electrical abnormality require further elucidation.
Purpose of the Study:
- To investigate the prevalence and characteristics of patients presenting with both RAD and LBBB.
- To analyze the relationship between RAD and LBBB, including their fixed or episodic nature and potential triggers.
Main Methods:
- Retrospective analysis of a large electrocardiogram database (636,000 records).
- Identification and detailed review of 36 cases exhibiting concurrent RAD and LBBB.
- Correlation of ECG findings with clinical data, particularly cardiac conditions like dilated cardiomyopathy.
Main Results:
- The majority of the 36 patients had dilated cardiomyopathy with biventricular enlargement.
- LBBB was fixed in 21 cases and episodic in 15. RAD was episodic in 30 cases.
- A novel finding was the elicitation of combined LBBB and RAD with atrial premature impulses in 4 cases, suggesting a rare QRS aberration.
Conclusions:
- The combination of RAD and LBBB is rare, often associated with dilated cardiomyopathy.
- RAD is frequently episodic, while LBBB can be fixed or intermittent.
- Atrial premature impulses can unmask this combination, highlighting its complex electrophysiological basis and potential link to right ventricular overload.