title: Effects of simulated left bundle branch block on QRST time-integral values of 12-lead electrocardiograms in patients with and without prior anterior wall myocardial infarction.
abstract: The effects of right ventricular pacing, which simulated left bundle branch block (BBB), on QRST time-integral values of 12-lead electrocardiograms (ECGs) were examined, and the clinical usefulness of QRST values for estimating the severity of left ventricular wall motion abnormalities due to a prior anterior wall myocardial infarction (MI) in the setting of left BBB were evaluated. Digitized ECGs were recorded during normal sinus rhythm and simulated left BBB in 38 patients (24 with and 14 without prior anterior wall MI). QRST values were calculated in each lead point of 12-lead ECGs. Data from 608 normal subjects were used as control values; the mean +/- 2 SD of these values was regarded as the normal range. The parameter sigma DE was defined as the sum of the differences between the normal mean QRST value and the QRST values of a given patient in leads where the QRST value was less than the normal range. The correlation coefficient of sigma DE for the 2 activation sequences was highly significant. Although small but significant changes were seen in QRST values in leads I, II, III, aVR, aVF and V1 during simulated left BBB, left precordial leads showed no significant changes in QRST values. A criterion of sigma DE > 40 mV.ms for detecting an anterior wall MI showed a sensitivity of 88%, a specificity of 93%, and a diagnostic accuracy of 89%. The sigma DE was significantly (p < 0.001) correlated with the asynergy index calculated from left ventriculograms.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Hirai
authors.forename: A
authors.initials: A
authors.lastname: Suzuki
authors.forename: H
authors.initials: H
authors.lastname: Hayashi
authors.forename: Y
authors.initials: Y
authors.lastname: Tomita
authors.forename: M
authors.initials: M
authors.lastname: Adachi
authors.forename: Y
authors.initials: Y
authors.lastname: Ichihara
authors.forename: T
authors.initials: T
authors.lastname: Terazawa
authors.forename: F
authors.initials: F
authors.lastname: Takatsu
authors.forename: H
authors.initials: H
authors.lastname: Saito
mesh_terms: D002037:Bundle-Branch Block / Q000150:complications / Q000503:physiopathology*; D006328:Cardiac Catheterization; D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D012016:Reference Values; D012815:Signal Processing, Computer-Assisted; D016277:Ventricular Function, Left / Q000502:physiology*