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[Left bundle branch block analysis by body surface mapping. Comparison with electrocardiographic and
C A Pastore1, P J Moffa, N M Tobias
1Instituto do Coração do Hospital das Clínicas, FMUSP.
Insights
The departure areas (DA) of ST-T waves, particularly negative, show potential in differentiating left bundle branch block (LBBB) with left ventricular hypertrophy (LVH) or myocardial infarction (MI). Current ECG/VCG criteria are insufficient for this differential diagnosis.
Area of Science:
- Cardiology
- Medical Diagnostics
Background:
- Left bundle branch block (LBBB) can complicate the diagnosis of left ventricular hypertrophy (LVH) and myocardial infarction (MI).
- Traditional electrocardiogram (ECG) and vectocardiogram (VCG) criteria may not reliably distinguish these conditions when LBBB is present.
Purpose of the Study:
- To compare the diagnostic utility of departure areas (DA), positive or negative, in patients with LBBB.
- To assess the correlation of DA with LVH and MI against established ECG/VCG criteria.
Main Methods:
- Analysis of 46 patients with LBBB, including those with hypertension, coronary heart disease, and no heart disease.
- Statistical analysis using the Cluster method to divide patients into groups based on QRS and ST-T departure areas.
Main Results:
- Patients were divided into two groups based on DA values for QRS and ST-T.
- Significant differences in DA rates were observed between the groups, particularly for ST-T negative departure areas.
Conclusions:
- Current ECG/VCG findings are generally inadequate for differentiating LBBB associated with LVH and MI.
- Negative ST-T departure areas demonstrated the highest efficiency in separating patient groups and aiding differential diagnosis.
Purpose:
To compare the correlation between the departure areas (DA), negative or positive, in patients whose electrocardiogram showed left bundle branch block (LBBB) and association with left ventricular hipertrophy (LVH) and myocardial infarction (MI), to the electrocardiographic (ECG) and vectocardiographic (VCG) classic criteria.
Methods:
The study was carried out with 46 patients (27 males) with LBBB. These patients had hypertension (19.5%), coronary heart disease (34.7%) and 21 patients with no heart disease (45.8%).
Results:
The statistic analysis using the Cluster method divided the patients in two groups. Group I (22 patients) showed an average rate for the DA (-2 SD) of 1091 for QRS and of 640 for ST-T. For the DA (+2 SD), the average rate was 618 for QRS and 881 for ST-T; group II (24 patients) showed an averaged for the DA (-2 SD) of 1063 for QRS and of 225 for ST-T. For the DA (+2 SD), the averaged rate was 428 for QRS and 600 for ST-T.
Conclusion:
In general the current ECG/VCG findings, can not differentiate the presence of the association of LBBB to LVH and MI. The DA of ST-T, mainly negative was the most efficient to separate the two groups and help in the differential diagnosis.