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Related Experiment Videos

The pathologic correlates of the electrocardiogram: complete left bundle branch block.

C J Havelda, G S Sohi, N C Flowers

    Circulation
    |March 1, 1982
    PubMed
    Summary

    Hearts with left bundle branch block (LBBB) and left-axis deviation (LAXD) showed larger inferoposterolateral and apical infarcts compared to those with LBBB and normal axis. Electrocardiogram (ECG) signs for diagnosing left ventricular enlargement and infarction in LBBB require careful interpretation.

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    Area of Science:

    • Cardiology
    • Pathology
    • Electrocardiography

    Background:

    • Left bundle branch block (LBBB) is a common electrocardiographic finding.
    • Left-axis deviation (LAXD) in the presence of LBBB may indicate underlying cardiac pathology.
    • Understanding gross pathologic differences can improve diagnostic accuracy.

    Purpose of the Study:

    • To investigate pathological differences in hearts with LBBB and LAXD versus LBBB with a normal axis.
    • To assess the accuracy of ECG criteria for diagnosing left ventricular enlargement and myocardial infarction in LBBB.

    Main Methods:

    • Examination of 70 hearts with LBBB from 1410 sequential dissections.
    • Correlation of gross pathology with electrocardiographic findings (LAXD vs. normal axis).
    • Quantitative analysis of infarct size and location, ventricular weight, and coronary anatomy.

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    Main Results:

    • Left ventricular enlargement was frequent (93%) in hearts with LBBB.
    • No significant differences in age, ventricular weight, coronary anatomy, or infarct location were found between the LBBB/LAXD and LBBB/normal axis groups.
    • Hearts with LBBB and LAXD exhibited significantly larger inferoposterolateral and apical infarcts (p < 0.01).
    • ECG voltage criteria and QRS duration showed poor accuracy for defining chamber enlargement.
    • Specific ECG patterns were identified for anterior infarction, and inferior infarction had high specificity but low sensitivity.

    Conclusions:

    • Left-axis deviation in LBBB is associated with larger inferoposterolateral and apical infarcts.
    • Standard ECG criteria for chamber enlargement are unreliable in LBBB.
    • Specific ECG findings can suggest anterior infarction, while inferior infarction diagnosis remains challenging.