ECG parameters predict left ventricular conduction delay in patients with left ventricular dysfunction

Heart Rhythm. 2016 Dec;13(12):2289-2296. doi: 10.1016/j.hrthm.2016.07.010. Epub 2016 Jul 14.


Background: Estimating left ventricular electrical delay (Q-LV) from a 12-lead ECG may be important in evaluating cardiac resynchronization therapy (CRT).

Objective: The purpose of this study was to assess the impact of Q-LV interval on ECG configuration.

Methods: One hundred ninety-two consecutive patients undergoing CRT implantation were divided electrocardiographically into 3 groups: left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (IVCD). The IVCD group was further subdivided into 81 patients with left (L)-IVCD and 15 patients with right (R)-IVCD (resembling RBBB, but without S wave in leads I and aVL). The Q-LV interval in the different groups and the relationship between ECG parameters and the maximum Q-LV interval were analyzed.

Results: Patients with LBBB presented a long Q-LV interval (147.7 ± 14.6 ms, all exceeding cutoff value of 110 ms), whereas RBBB patients presented a very short Q-LV interval (75.2 ± 16.3 ms, all <110 ms). Patients with an IVCD displayed a wide range of Q-LV intervals. In L-IVCD, mid-QRS notching/slurring showed the strongest correlation with a longer Q-LV interval, followed, in decreasing order, by QRS duration >150 ms and intrinsicoid deflection >60 ms. Isolated mid-QRS notching/slurring predicted Q-LV interval >110 ms in 68% of patients. The R-IVCD group presented an unexpectedly longer Q-LV interval (127.0 ± 12.5 ms; 13/15 patients had Q-LV >110 ms).

Conclusion: Patients with LBBB have a very prolonged Q-LV interval. Mid-QRS notching in lateral leads strongly predicts a longer Q-LV interval in L-IVCD patients. Patients with R-IVCD constitute a subgroup of patients with a long Q-LV interval.

Keywords: Cardiac resynchronization therapy; Heart failure; Left bundle branch block; Left ventricular electrical delay; Nonspecific intraventricular conduction delay; Right bundle branch block.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bundle-Branch Block* / diagnosis
  • Bundle-Branch Block* / physiopathology
  • Bundle-Branch Block* / therapy
  • Cardiac Resynchronization Therapy / methods*
  • Electrocardiography / methods*
  • Female
  • Heart Conduction System* / diagnostic imaging
  • Heart Conduction System* / physiopathology
  • Heart Ventricles / physiopathology
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Statistics as Topic
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / physiopathology