Related Experiment Video
Updated: Jul 6, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Electrocardiographic predictors of left ventricular scar in athletes with right bundle branch block premature
Luigi Sciarra1, Paolo Golia2, Antonio Scarà1,3
1Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito (AQ), Italy.
Insights
Specific electrocardiogram (ECG) abnormalities can help identify non-ischaemic left ventricular scar (NLVS) in athletes with right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs). A score of 1 or higher on specific ECG findings accurately detects NLVS.
Area of Science:
- Cardiology
- Sports Medicine
- Diagnostic Imaging
Background:
- Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) are linked to non-ischaemic left ventricular scar (NLVS) in athletes.
- Identifying NLVS is crucial for risk stratification and management in this population.
Purpose of the Study:
- To determine clinical and electrocardiogram (ECG) predictors of NLVS in athletes presenting with RBBB VAs.
- To develop a predictive tool for NLVS detection using non-invasive methods.
Main Methods:
- Cross-sectional study involving 64 athletes with RBBB VAs.
- Cardiac magnetic resonance (CMR) with late gadolinium enhancement used to assess for NLVS.
- Statistical analysis to identify ECG variables associated with NLVS.
Main Results:
- 56% of athletes had NLVS confirmed by CMR.
- Seven ECG variables, including low QRS voltages and specific T-wave abnormalities, were associated with NLVS.
- An ECG score of ≥2 showed 86% sensitivity and 100% specificity for NLVS; a score ≥1 identified all cases.
Conclusions:
- Specific 12-lead ECG abnormalities are valuable in detecting NLVS in athletes with RBBB VAs.
- An ECG-based scoring system can aid in identifying athletes requiring further investigation with CMR.
Aims:
Right bundle branch block (RBBB) morphology non-sustained ventricular arrhythmias (VAs) have been associated with the presence of non-ischaemic left ventricular scar (NLVS) in athletes. The aim of this cross-sectional study was to identify clinical and electrocardiogram (ECG) predictors of the presence of NLVS in athletes with RBBB VAs.
Methods And Results:
Sixty-four athletes [median age 39 (24-53) years, 79% males] with non-sustained RBBB VAs underwent cardiac magnetic resonance (CMR) with late gadolinium enhancement in order to exclude the presence of a concealed structural heart disease. Thirty-six athletes (56%) showed NLVS at CMR and were assigned to the NLVS positive group, whereas 28 athletes (44%) to the NLVS negative group. Family history of cardiomyopathy and seven different ECG variables were statistically more prevalent in the NLVS positive group. At univariate analysis, seven ECG variables (low QRS voltages in limb leads, negative T waves in inferior leads, negative T waves in limb leads I-aVL, negative T waves in precordial leads V4-V6, presence of left posterior fascicular block, presence of pathologic Q waves, and poor R-wave progression in right precordial leads) proved to be statistically associated with the finding of NLVS; these were grouped together in a score. A score ≥2 was proved to be the optimal cut-off point, identifying NLVS athletes in 92% of cases and showing the best accuracy (86% sensitivity and 100% specificity, respectively). However, a cut-off ≥1 correctly identified all patients with NLVS (absence of false negatives).
Conclusion:
In athletes with RBBB morphology non-sustained VAs, specific ECG abnormalities at 12-lead ECG can help in detecting subjects with NLVS at CMR.
More Related Videos
12:45Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
08:10Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin...
01:28Disturbances in Heart Rhythm
Arrhythmias are categorized by their speed, rhythm, and origin. A slow...
01:25Correlation between ECG and Cardiac Cycle
A cardiac action potential originates in the SA node and spreads throughout the atria and the AV node in approximately 0.03 seconds. This results in the P wave in an ECG and triggers atrial contraction. The action potential is then briefly slowed at the AV node, allowing the atria to contract and fill the ventricles with blood before...
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials
01:19Electrophysiology of Normal Cardiac Rhythm