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

Abstract

There are few data evaluating electrocardiographic diagnosis of left ventricular (LV) hypertrophy in the presence of right bundle branch block (BBB). This study assesses the relative value of multiple electrocardiographic variables for detecting LV hypertrophy in patients with right BBB. LV hypertrophy was defined as LV mass ≥215 g calculated from the Penn method using standard M-mode echo measurements. Sixty-two patients were evaluated (ages 41 to 94) and 35 had LV hypertrophy. None of the electrocardiographic criteria was sensitive; the best was mean QRS axis ≤−30 ° (sensitivity 52%) and excessive negative P terminal force (sensitivity 28%). Several electrocardiographic variables were specific: Sokolow index ≥35 mm (100%), RV 5 or RV 6 ≥25 mm (96.3%), RI + SIII ≥25 mm (92.6%) and intrinsicoid deflection ≥0.05 seconds (88.5%). Conventional electrocardiographic criteria do not reliably detect LV hypertrophy in the presence of right BBB, but several criteria are relatively specific for LV hypertrophy.