Vectocardiographic analysis of right ventricular electrical conduction delay

Authors

  • Augusto Armando de Lucca Junior a Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário FMABC, Santo André, SP, Brazil
  • Rodrigo Daminello Raimundo a Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário FMABC, Santo André, SP, Brazil
  • Raimundo Barbosa Barros b Coronary Center of the Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brazil
  • Rodrigo de Souza Abreu a Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário FMABC, Santo André, SP, Brazil
  • Kjell Nikus d Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Finland;
  • Andrés Ricardo Pérez-Riera a Laboratório de Metodologia de Pesquisa e Escrita Científica, Centro Universitário FMABC, Santo André, SP, Brazil; e Clínica Médica, Universidade Uninove, Mauá, SP, Brazil

DOI:

https://doi.org/10.36311/jhgd.v32.13778

Keywords:

Electrical stimulation, Branch block

Abstract

Introduction: The electrocardiographic interpretation of end conduction delay (ECD) in the right ventricular branch of the heart has already generated some hypotheses that this right branch is not single, as anatomically demonstrated, and can be divided into distinct terminal branches when we analyze tracings through the vectorcardiogram.

Methods: There were 227 electrocardiograms selected, with typical characteristics defined as ECD of patients from the electrocardiography service of the Centro Universitário Saúde ABC, of both sexes, in the age range of 18 to 87 years, with varied ethnicities, weight and height, with cardiovascular risk factors or without them. We performed vectorcardiograms in these patients to observe the behavior of the final portion of electrical conduction.

Results: Analyzing the vectorcardiographic tracings of patients who presented ECD in electrocardiogram, we confirmed in the recording by the frontal plane, the presence of ECD but recorded in three distinct regions; 103 patients in the right upper quadrant between -120° and -150°, 45 patients in the right lower quadrant between +170° and -170°, and medial, and 79 patients in the right lower quadrant between +110° and + 140°.

Conclusion: Electrical depolarization of the heart in the right ventricle in electrocardiographic tracings apparently records typical alterations that we can diagnose as depolarization of a single bundle; but when we performed vectorcardiograms, we recorded three distinct zones of right ventricular depolarization with delay; i.e., three distinct sectors of right ventricle free wall delay, such as type I (upper), type II (lower) and type III (medial).

Downloads

Download data is not yet available.

References

Pastore CA, Pinho JA, Pinho C, Samesima N, Pereira Filho HG, Kruse JC, et al. III Diretrizes da Sociedade Brasileira De Cardiologia Sobre Análise e Emissão de Laudos Eletrocardiográficos. Arq Bras Cardiol. 2016; 106(4 Suppl 1): 1-23.

Pastore CA, Moffa PJ, Tobias NM, de Moraes AP, Nishioka SA, Chierighini JE, et al. [Segmental blocks of the right bundle-branch and electrically inactive areas. Differential electro-vectorcardiographic diagnosis]. Arq Bras Cardiol. 1985; 45(5): 309-17.

Maheshwari S, Acharyya A, Schiariti M, Puddu PE. Frank vectorcardiographic system from standard 12 lead ECG: An effort to enhance cardiovascular diagnosis. J Electrocardiol. 2016; 49(2): 231-42.

Pérez-Riera AR. Value of 12 lead electrocardiogram and derived methodolgies in the diagnosis of Brugada disease. In: Antzelevitch C, editor. The Brugada Syndrome From Bench to Bedside. London: Blackwell Futura; 2005. p. 87-110.

Perez-Riera AR, Ferreira Filho C, de Abreu LC, Ferreira C, Yanowitz FG, Femenia F, et al. Do patients with electrocardiographic Brugada type 1 pattern have associated right bundle branch block? A comparative vectorcardiographic study. Europace. 2012; 14(6): 889-97.

Babai Bigi MA, Aslani A, Shahrzad S. aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada syndrome. Heart Rhythm. 2007; 4(8): 1009-12.

Luna Filho B, Bocanegra JA, Pfeferman A, Andrade JL, Martinez Filho EE. [Fascicular block of the His bundle: critical approach for its identification]. Arq Bras Cardiol. 1989; 53(5): 261-5.

O. BR, Mann DL, P. ZD, Libby P. Braunwald Tratado de doenças cardiovasculares. 9 ed. Brasil: Elsevier; 2013.

Nagao K, Toyama J, Kodama I, Yamada K. Role of the conduction system in the endocardial excitation spread in the right ventricle. Am J Cardiol. 1981; 48(5): 864-70.

Moore EN, Hoffman BF, Patterson DF, Stuckey JH. Electrocardiographic Changes Due to Delayed Activation of the Wall of the Right Ventricle. Am Heart J. 1964; 68: 347-61.

Smith LA, Kennamer R, Prinzmetal M. Studies on the mechanism of ventribular activity. IV. Ventricular excitation in segmental and diffuse types of experimental bundle-branch block. Circ Res. 1954; 2(3): 221-30.

Uhley HN, Rivkin LM. Electrocardiographic Patterns Following Interruption of the Main and Peripheral Branches of the Canine Left Bundle of His. Am J Cardiol. 1964; 13: 41-7.

Esmond WG, Moulton GA, Cowley RA, Attar S, Blair E. Peripheral Ramification of the Cardiac Conducting System. Circulation. 1963; 27(4): 732-8.

Torrent-Guasp F. Estructura y función del corazón. Rev Esp Cardiol. 1998; 51(2): 91-102.

Torrent-Guasp F, Kocica MJ, Corno A, Komeda M, Cox J, Flotats A, et al. Systolic ventricular filling. Eur J Cardiothorac Surg. 2004; 25(3): 376-86.

Downloads

Published

2022-10-31

Issue

Section

ORIGINAL ARTICLES