Electrocardiogram-based false positive diagnosis of left ventricular hypertrophy during tachycardia: What more needs...

Area of Science:

• Cardiology
• Medical Imaging
• Electrocardiography

Background:

• Electrocardiogram (ECG) interpretation for left ventricular hypertrophy (LVH) can be complex.
• Tachycardia, a rapid heart rate, can influence ECG findings.
• Previous observations suggested potential ECG abnormalities during tachycardia.

Purpose of the Study:

• To describe a transient false positive ECG diagnosis of LVH in patients with tachycardia.
• To elucidate the mechanism behind this ECG phenomenon.
• To suggest implications for automated ECG interpretation and heart failure diagnosis.

Main Methods:

• Retrospective analysis of ECGs and cardiac imaging from patients with various tachycardias.
• Review of established physiological principles related to cardiac dimensions and ECG signal transmission.
• Clinical correlation of ECG findings with imaging-verified LVH and heart failure status.

Main Results:

• A transient false positive ECG diagnosis of LVH was observed in patients with tachycardias (sinus, supraventricular, atrial fibrillation).
• The proposed mechanism involves tachycardia-induced shortening of diastolic left ventricular (LV) dimensions, displacing the LV volume centroid closer to the chest wall (Wilson's proximity effect).
• Absence of this phenomenon during tachycardia may suggest advanced heart failure with diastolic dilatation.

Conclusions:

• The observed ECG phenomenon can lead to inappropriate LVH diagnosis, necessitating awareness.
• Modified automated ECG interpretation algorithms are recommended to incorporate this insight.
• Understanding this ECG artifact aids in accurate LVH assessment and may offer clues to heart failure severity.