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A study of electrocardiographic and spatial vectorcardiographic changes in bundle branch block by means of the reconstruction method

Authors
Journal
American Heart Journal
0002-8703
Publisher
Elsevier
Publication Date
Volume
52
Issue
5
Identifiers
DOI: 10.1016/0002-8703(56)90026-6
Disciplines
  • Medicine

Abstract

Abstract 1. 1. The relationships between the electrocardiographic and spatial vectorcardiographic changes and ventricular activation process in the heart with bundle branch block were examined by means of the reconstruction of ECG's and spatial VCG's. 2. 2. For the reconstruction of ECG's and spatial VCG's, a decomposable plaster model of the heart consisting of five blocks was used in order to make possible solid angle measurements on the free and septal endocardial surfaces. 3. 3. In left bundle branch block, the features of the ECG in the standard three leads were always of the common type whichever wall, anterior or posterior, of the blocked side ventricle was activated earlier; and the features of the six standard precordial leads were always ones typical of L.B.B.B. The spatial VCG was displaced to the left-posterior-superior, and slow terminal portion was inscribed in the left-posterior-superior aspect. 4. 4. In R.B.B.B., the feature of the three standard extremity lead ECG's were of the usual type of Wilson block when the posterior wall of the blocked side ventricle was activated earlier than the homolateral anterior wall, and of the rare type of B.B.B. when the homolateral anterior wall was activated earlier than the homolateral posterior wall. The features of the standard six precordial lead ECG's were nearly the same in both cases. The spatial VCG was displaced to the right-anterior-posterior and the slow terminal portion was inscribed in the right-anterior-posterior aspect. 5. 5. In the combined R.B.B.B. and left posterior branch block, the features of the three standard extremity lead ECG's were those of the rare type of B.B.B. and the features of the six standard precordial lead ECG's and spatial VCG were nearly the same as those in R.B.B.B. 6. 6. If it is possible for the homolateral anterior wall to be activated earlier than the homolateral posterior wall in the isolated R.B.B.B., the appearance of the rare type of B.B.B. is possible in the isolated R.B.B.B. 7. 7. In the isolated left posterior branch block, the three standard extremity lead ECG's were characterized by a slow appendant wave in the terminal portion of the QRS complex in Leads II, III, and often in I. In the spatial VCG, there was no particular characterization. 8. 8. As criteria for diagnosis of right or left B.B.B., the precordial lead ECG is the most important.

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