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Related Experiment Video

Updated: May 5, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Redefining left bundle branch block from high-density electroanatomical mapping.

Jun-Hua Zou1, Bao-Tong Hua2, Xiao-Xia Shao2

  • 1The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.

International Journal of Cardiology
|February 6, 2024
PubMed
Summary

Existing electrocardiogram (ECG) criteria for left bundle branch block (LBBB) lack accuracy. Measuring the notch width to left ventricular diameter ratio (Nw/LVd) improves diagnosis of true LBBB.

Keywords:
Cardiac resynchronization therapy (CRT)High-density three-dimensional electroanatomical mappingLeft bundle branch block (LBBB)

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Current electrocardiogram (ECG) criteria for diagnosing left bundle branch block (LBBB) are insufficient for accurate differentiation between true and false blocks.
  • Distinguishing true LBBB from LBBB-like patterns is crucial for appropriate patient management and treatment, particularly in cardiac resynchronization therapy (CRT) candidates.

Purpose of the Study:

  • To investigate the utility of QRS notch width in lateral leads as a supplementary diagnostic marker for true complete left bundle branch block (t-LBBB).
  • To evaluate the diagnostic performance of the notch width to left ventricular end-diastolic diameter (Nw/LVd) ratio in differentiating t-LBBB from false LBBB (f-LBBB).

Main Methods:

  • Utilized high-density, 3D electroanatomical mapping in 37 CRT patients with LBBB-like ECGs.
  • Defined t-LBBB and f-LBBB based on the presence or absence of left bundle branch potentials from base to apex.
  • Compared clinical characteristics, electrical excitation spread, QRS notch width, and Nw/LVd ratio between t-LBBB and f-LBBB groups.
  • Performed ROC analysis to determine the sensitivity and specificity of Nw/LVd for diagnosing t-LBBB.

Main Results:

  • Twenty-five patients were classified as t-LBBB and 12 as f-LBBB.
  • Distinct patterns of QRS notch depolarization were observed between t-LBBB and f-LBBB groups.
  • The Nw/LVd ratio showed a statistically significant difference between the groups (0.65 ± 0.19 ms/mm vs. 0.81 ± 0.17 ms/mm, P < 0.05).
  • ROC analysis yielded a sensitivity of 56% and a specificity of 91.7% for diagnosing t-LBBB using the Nw/LVd ratio.

Conclusions:

  • The Nw/LVd ratio serves as a valuable quantitative marker to enhance the diagnostic accuracy of LBBB.
  • Incorporating the Nw/LVd measurement into existing ECG criteria can improve the identification of true LBBB.