Electrocardiographic criteria for diagnosis of left ventricular hypertrophy in the presence of complete right bundle branch block

Abstract

The usual electrocardiographic criteria recommended for left ventricular (LV) hypertrophy may be unreliable in the presence of complete right bundle branch block (BBB). Thirty-six standard electrocardiographic criteria for LV hypertrophy were evaluated in 100 patients (mean age ± standard deviation 67 ± 11 years) with right BBB and technically satisfactory echocardiograms. Eight additional electrocardiographic criteria derived from this study also were evaluated. LV mass index was determined from the echocardiogram using the Penn method. LV hypertrophy defined as LV mass index >132 g/m 2 in men and 109 g/m 2 in women was present in 56 of the 100 patients. Electrocardiographic criteria with the highest sensitivity were SIII + (R + S) maximal precordial lead ≥30 mm (sensitivity 68%, specificity 66%), left axis deviation of −30 ° to −90 ° (sensitivity 59%, specificity 71%) and combination of left axis deviation and SIII + (R + S) maximal precordial lead ≥30 mm (sensitivity 52%, specificity 84%). The electrocardiographic criteria with the highest sensitivity and specificity >90% were left axis deviation of −30 ° to −90 ° and SV 1 > 2 mm (sensitivity 34%), point-score system, RaVL > 12 mm and RI + SIII > 25 mm (each with a sensitivity of 27%). In general, limb lead voltage criteria such as RaVL > 11 mm (sensitivity 29%, specificity 86%) had higher sensitivities than criteria using right precordial lead S-wave voltage criteria such as SV 1 + RV 5, V 6 > 35 mm (sensitivity 2%, specificity 100%). These data indicate that, in the presence of complete right BBB, electrocardiographic criteria for LV hypertrophy based on the magnitude of right precordial lead S waves have a very low sensitivity, and electrocardiographic recognition of LV hypertrophy will depend primarily on limb lead criteria or combinations of criteria.