DOI: http://dx.doi.org/10.18203/2349-3933.ijam20210520

Electromechanical delay in right bundle branch block: suggestive predictor of right ventricular systolic function

Dheerendra Kuber, Shekhar Kunal, Anoop Jain

Abstract


Background: RV dysfunction is a powerful predictor of prognosis in cardiopulmonary diseases. Recognition of RV dysfunction is clinically important, because impairment of RV systolic function is independently associated with adverse outcomes. ECG may serve as a simple tool for detection of underlying RV dysfunction in patients with RBBB.

Methods: Patients with complete RBBB (n=225) who underwent ECG and echocardiography were screened from May 2017 to Jan 2019. Demographic, comorbidity data, ECGs and echocardiography were obtained. QRS and R’ duration was measured. RV dysfunction was defined by RV FAC<35%, TAPSE<17 and RV TEI Index>0.54.

Results: As compared to normal RV function, patients with RV dysfunction showed reduced TAPSE and RV FAC and increased RV systolic pressure, RV dimension and RV myocardial performance index (all p<0.05). The R′ duration was significantly associated with RV FAC (r=-0.615, p<0.001), RV systolic pressure (r=0.138, p=0.008), RV dimension (r=0.189, p<0.001) and RV Myocardial Performance Index (r=0.190, p<0.001). On ROC curve analysis, V1R′ duration>100 ms was associated with RV dysfunction with 40% sensitivity and 90% specificity (AUC: 0.883; p<0.001). Lead V1 QRS duration>137 ms and the ratio of R′:QRS duration was also useful for predicting RV dysfunction (all p<0.001).  

Conclusions: In patient with RBBB, the electromechanical delay has a correlation with RV systolic dysfunction. R′ prolongation in lead V1 can be a useful marker to determine the presence of underlying RV dysfunction as a non-expensive tool.  


Keywords


Electromechanical delay, Right bundle branch block, Right ventricular systolic function, TAPSE

Full Text:

PDF

References


Tusscher KH, Panfilov AV. Modelling of the ventricular conduction system. Prog. Biophys. Mol. Biol. 2008;96:152-70.

Horowitz LN, Alexander JA, Edmunds LH Jr. Postoperative right bundle branch block: identification of three levels of block. Circulation. 1980;62:319.

Sabe MA, Sabe SA, Kusunose K, Flamm SD, Griffin BP, Kwon DH. Predictors and Prognostic Significance of Right Ventricular Ejection Fraction in Patients With Ischemic Cardiomyopathy. Circulation. 2016;134:656-65.

Fernández-Lozano I, Brugada J. Right bundle branch block: are we looking in the right direction? Eur Heart J. 2013;34:86-8.

Adams JC, Nelson MR, Chandrasekaran K, Jahangir A, Srivathsan K. Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block. Int J Cardiol. 2013;167:1385-9

Devarapally SR, Arora S, Ahmad A, Sood M, El Sergany A, Sacchi T, et al. Right ventricular failure predicted from right bundle branch block:cardiac magnetic resonance imaging validation. Cardiovasc Diagn Ther 2016;6:432-8.

DiLorenzo MP, Bhatt SM, Mercer-Rosa L. How best to assess right ventricular function by echocardiography. Cardiol Young. 2015;25:1473-81.

Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, et al. American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology. American College of Cardiology Foundation. Heart Rhythm Society. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: 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. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53:976-81.

Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32:1-64

Bussink BE, Holst AG, Jespersen L, Deckers JW, Jensen GB, Prescott E. Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study. Eur Heart J. 2013;34:138-46.

Rosenman RH, Pick A, Katz LN: The electrocardiographic patterns and the localization of intraventricular conduction defects. Am Heart J 1950;40:845-66.

Braunwald E, Morrow AG. Sequence of ventricular contraction in human bundle branch block; a study based on simultaneous catheterization of both ventricles. Am J Med. 1957;23:205-11.

Brooks N, Leech G, Leatham A. Complete right bundle branch block. Echophonocardiographic study of first heart sound and right ventricular contraction times. Br Heart J 1979;41: 37-46.

Dancy M, Leech G, Leatham A. Significance of complete right bundle-branch block when an isolated finding. An echocardiographic study. Br Heart J. 1982;48:217-21.

Adams JC, Nelson MR, Chandrasekaran K, Jahangir A, Srivathsan K. Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block. Int J Cardiol 2013;167:1385–9

Park DH, Cho KI, Kim YK, Kim BJ, You GI, Im SI, et al. Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block. J Cardiol. 2017;70:470-5.