Journal of Electrocardiology
Volume 43, Issue 3 , Pages 200-208 , May 2010

Effect of changes in left ventricular anatomy and conduction velocity on the QRS voltage and morphology in left ventricular hypertrophy: a model study

  • Ljuba Bacharova, MD, PhD, MBA

      Affiliations

    • International Laser Center, Bratislava, Slovakia
    • Corresponding Author InformationCorresponding author. International Laser Center, Ilkovicova 3, 841 04 Bratislava, Slovak Republic.
    • ,
  • Vavrinec Szathmary, RNDr, PhD

      Affiliations

    • Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
    • ,
  • Matej Kovalcik, Mgr

      Affiliations

    • Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
    • ,
  • Anton Mateasik, RNDr, PhD

      Affiliations

    • International Laser Center, Bratislava, Slovakia

Received 26 May 2009

References 

  1. Romhilt DW, Estes EH. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J. 1968;75:752
  2. Molloy TJ, Okin PM, Devereux RB, Kligfield P. Electrocardiographic detection of left ventricular hypertrophy by the simple QRS voltage-duration product. J Am Coll Cardiol. 1992;20:1180
  3. Hancock EW, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram. Part V: electrocardiogram changes associated with cardiac chamber hypertrophy a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. J Am Coll Cardiol. 2009;53:992
  4. Yano K, Pipberger HV. Correlations between radiologic heart size and orthogonal electrocardiograms in patients with left ventricular overload. Am Heart J. 1964;67:44
  5. Reichek N, Devereux RB. Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings. Circulation. 1981;63:1391
  6. Casale PN, Devereux RB, Kligfield P, et al. Electrocardiographic detection of left ventricular hypertrophy: development and prospective validation of improved criteria. J Am Coll Cardiol. 1985;6:572
  7. Pewsner D, Jüni P, Egger M, Battaglia M, Sundström J, Bachmann LM. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007;335:711
  8. Bacharova L, Kyselovic J, Klimas J. The initial stage of left ventricular hypertrophy in spontaneously hypertensive rats is manifested by a decrease in the QRS/left ventricular mass ratio. Clin Exp Hypertens. 2004;26:557
  9. Bacharova L, Michalak K, Kyselovic J, Klimas J. Relation between QRS amplitude and left ventricular mass in the initial stage of exercise-induced left ventricular hypertrophy in rats. Clin Exp Hypertens. 2005;27:533
  10. Bacharova L, Tibenska M, Kucerova D, Kyselovicova O, Medekova H, Kyselovic J. Decrease in QRS amplitude in juvenile female competitive athletes during the initial twenty one months of intensive training. J Cardiol. 2007;14:260
  11. Bacharova L, Baum OV, Muromtseva GA, et al. The relation between QRS amplitude and left ventricular mass in patients with mild hypertension identified at screening. Anatolian J Cardiol. 2007;7(Suppl 1):153
  12. Bacharova L. The “high voltage trap” in the electrocardiographic diagnosis of left ventricular hypertrophy. J Electrocardiol. 2008;41:351
  13. Bacharova L, Plandorova J, Klimas J, Krenek P, Kyselovic J. Discrepancy between increased left ventricular mass and “normal” QRS voltage is associated with decreased connexin43 expression in early stage of left ventricular hypertrophy in spontaneously hypertensive rats. J Electrocardiol. 2008;41:730
  14. Szathmáry V, Osvald R. An interactive computer model of propagated activation with analytically defined geometry of ventricles. Comput Biomed Res. 1994;27:27
  15. Szathmáry V. Model based analysis of the cardiac electric field. In:  Pecháňová O,  Jagla F editor. Selected diseases of civilization—basic mechanisms and clinical implications. Bratislava: Comenius University; 2006;p. 105
  16. Yan GX, Antzelevitch Ch. Cellular basis for the normal T wave and the electrocardiographic manifestation of the long-QT syndrome. Circulation. 1998;98:1928
  17. Hutchins GM, Bulkley BH, Moore GW, Piasio MA, Lohr FT. Shape of the human cardiac ventricles. Am J Cardiol. 1978;41:646
  18. Durrer D, van Dam RT, Freud GE, Janse MJ, Meijler FL, Arzbaecher RC. Total excitation of the isolated human heart. Circulation. 1970;41:899
  19. Dower GE, Machado HB, Osborne JA. On deriving the electrocardiogram from vectorcardiographic leads. Clin Cardiol. 1980;3:87
  20. Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation. 1987;75:565
  21. Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37:161
  22. Cabrera E, Estes EH, Hellerstein H. In:  Hurst JW,  Wenger N editor. Electrocardiographic interpretation. New York: McGraw Hill; 1963;p. 50
  23. McIntyre H, Fry CH. Abnormal action potential conduction in isolated human hypertrophied left ventricular myocardium. J Cardiovasc Electrophysiol. 1997;8:887
  24. Cooklin M, Wallis WR, Sheridan DJ, Fry CH. Conduction velocity and gap junction resistence in hypertrophied, hypoxic guinea-pig left ventricular myocardium. Exp Physiol. 1998;83:763
  25. Carey PA, Turner M, Fry CH, Sheridan DJ. Reduced anisotropy of action potential conduction in left ventricular hypertrophy. J Cardiovasc Electrophysiol. 2001;12:830
  26. Botchwaya AN, Turnera MA, Sheridana DJ, Floresa NA, Fryb CH. Electrophysiological effects accompanying regression of left ventricular hypertrophy. Cardiovasc Res. 2003;60:510
  27. Kamei K, Maehara K, Kimura J, Ishibashi T, Maruyama Y. Comprehensive analyses of arrhythmogenic substrates and vulnerability to ventricular tachycardia in left ventricular hypertrophy in salt-sensitive hypertensive rats. Circ J. 2007;71:390
  28. Lai1 YJ, Chen YY, Cheng CP, et al. Changes in ionic currents and reduced conduction velocity in hypertrophied ventricular myocardium of Xinα-deficient mice. Anatolian J Cardiol. 2007;7(Suppl 1):90
  29. Warma N, Jia P, Rudy Y. Electrocardiographic imaging of patients with heart failure with left bundle branch block and response to cardiac resynchronization therapy. J Electrocardiol. 2007;40(Suppl):S174
  30. Das MK, Cheriparambil K, Bedi A, et al. Prolonged QRS duration (QRS ≥ 170 ms) and left axis deviation in the presence of left bundle branch block: a marker of poor left ventricular systolic function?. Am Heart J. 2001;142:756
  31. Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Dahlof B. for the LIFE study investigators: baseline characteristics in relation to electrocardiographic left ventricular hypertrophy in hypertensive patients. Hypertension. 2000;36:7866
  32. Bacharova L. Electrical and structural remodeling in left ventricular hypertrophy—a substrate for a decrease in QRS voltage?. Ann Noninvasive Electrocardiol. 2007;12:260
  33. Kleber AG, Rudy J. Basic mechanisms of cardiac impulse propagation and associated arrhythmias. Physiol Rev. 2004;84:431
  34. Bacharova L. What is recommended and what remains open in the AHA recommendations for the standardization and interpretation of the electrocardiogram. Part V: electrocardiogram changes associated with cardiac chamber hypertrophy. J Electrocardiol. 2009;42:388
  35. Bacharova L. ECG-LVM discrepancies in LVH: ECG imperfection or beyond perfection?. J Electrocardiol. 2009;42:593

PII: S0022-0736(09)00326-4

doi: 10.1016/j.jelectrocard.2009.07.014

Journal of Electrocardiology
Volume 43, Issue 3 , Pages 200-208 , May 2010

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