Vectorcardiograms in severe aortic insufficiency. Clockwise rotation of QRS loop in the horizontal plane

In La Paz Hospital, Madrid, recently, vectorcardiograms (VCGs) were performed on 74 patients with aortic insufficiency. These cases presenting electrocardiographic and radiologic signs of left ventricular hypertrophy, were divided into three groups. In 25 patients (Group 1) the QRS loop in the horizontal plane (HP) showed counterclockwise rotation; 43 patients (Group 2) showed clockwise rotation; and 6 patients (Group 3) showed a pattern of left bundle branch block (LBBB). In Group 2, 31 of the 43 patients (group 2-A) had a Qloop of normal orientation and generally increased voltage, and in the remaining 12 patients (group 2-B) the Q loop was absent. All of the patients in Group 2 had severe aortic insufficiency. Thus, that group's valuation of the left ventricular hypertrophy using maximum QRS vector voltage in the HP, was higher than in Group 1 mean 3.75mV in Group 2 versus mean 2.71mV in Group 1 (p less than 0.01). Postoperative VCGs were performed in 12 patients of group 2-A, showing in all of them a clockwise to counterclockwise rotation change of the QRS loop in the HP. On the other hand, this fact was observed in only two of the eight patients in group 2-B. The clockwise rotation of the QRS loop in the HP is an important datum in our report, particularly in the diagnosis of severe aortic insufficiency. Conversely, a clockwise to counterclockwise rotation change would be a positive sign of good post operative evolution. Finally, two reasons are given to explain this anomalous rotation in the horizontal plane: dilatation and fibrosis.