Hemiblocks

REVIEW: Saudi Arabia has a high metabolic syndrome (MetS) prevalence. Having MetS increases the risk of cardiovascular disease (CVD), CVD mortality, and myocardial infarction (MI). There is a lack of information regarding MetS and electrocardiogram (ECG) abnormalities in Saudi Arabian populations. Further, it is unclear to what extent MetS components are associated with abnormal ECGs in Saudi populations. AIM: We investigated whether ECG abnormalities and MetS are associated with Saudi adults...

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Electrocardiographic patterns of right bundle branch and fascicular blocks were comprehensively analyzed in a two-phase study. The research aimed to address the scarcity of literature and the absence of standardized diagnostic criteria for these conditions. It revealed a weak correlation between the cardiac axis and age and highlighted the high misdiagnosis rate of these blocks. Furthermore, it discussed the challenges in fulfilling existing diagnostic criteria. The study emphasizes the need for a more precise understanding of right ventricular conduction disorders and the importance of developing robust diagnostic criteria...

In clinical practice, the accurate diagnosis of the causes of syncope is often challenging and demanding. Moreover, certain rare electrocardiographic phenomena may complicate the diagnostic workup, leading to imprecise diagnoses. The present study briefly describes the case of an 82-year-old male patient with ischemic cardiomyopathy who suffered syncopal episodes in the setting of trifascicular block. The 12-lead electrocardiogram revealed premature ventricular contractions and non-conducted P waves due to the phenomenon of retrograde concealed conduction...

This report describes two electrocardiograms (ECGs) showing unusual manifestations of left anterior hemiblock (LAH). One revealed different degrees of incomplete LAH and the other documented the occurrence of 2:1 LAH. Understanding different degrees of LAH helps to interpret the ECG with regard to intraventricular conduction disorders and other ECG abnormalities.

The main trunk of the right bundle branch divides into an anterior, middle (lateral) and posterior fascicle. This article describes the right anterior and posterior fascicular block. They present a diagnostic challenge and are often overlooked during diagnostic processes. The studied patients were young adults whose electrocardiographic tracings were registered at the Mexican Faculty of Medicine of La Salle University. The presence of delayed R-peak time in aVR and V1, along with the described ventricular complex morphologies, and a right or left deviation of the cardiac axis exceeding +60°, may be suggestive of right fascicular blocks...

BACKGROUND: Cavotricuspid isthmus pulsed-field ablation has been recently described to be safely performed despite initial reports on coronary arterial spasm while conduction disturbances as a complication of cavotricuspid isthmus ablation are rare and have been reported exclusively for radiofrequency catheter ablation. CASE SUMMARY: A 64-year-old female patient with mechanical prosthetic valves underwent atrial fibrillation ablation using the pentaspline pulsed-field ablation catheter...

BACKGROUND: A pacemaker implantation is not indicated in cases of reversible high-degree symptomatic sinus node dysfunction (SND) and atrioventricular block (AVB). However, it remains uncertain whether these reversible automaticity/conduction disorders may recur in some patients at follow-up, in the absence of reversible cause. This retrospective study aimed to determine the incidence and predictive factors of permanent pacemaker (PPM) implantation at follow-up and after reversible high-degree SND/AVB...

BACKGROUND: Greater degradation of the hybrid layer is expected when a universal adhesive system is used, especially in the conventional application strategy. Therefore, it would important to evaluate the effect of the ethanol (ETH) and a potential matrix protease inhibitor (caffeic acid phenethyl ester/ CAPE) to maximize the ability to achieve stable dentin bond strength. The aim of this study was to evaluated the effect of ETH on a wet-bonding technique, and dentin pretreatments with different concentrations of CAPE in ethanolic solution, followed by application of a universal adhesive system (Single Bond Universal) to inhibit proteolytic activity...

AIMS: Several procedural and electrocardiogram (ECG) parameters have been associated with the occurrence of high-degree atrioventricular block (AVB) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). We hereunder sought to assess if the baseline R-wave amplitude in V1 ECG lead of patients with normal QRS duration undergoing TAVR is associated with a higher patient's risk for developing high-degree AVB following left bundle branch block (LBBB)...

PURPOSE: The Tpeak-Tend interval of the T wave has emerged as a new electrocardiographic marker of increased transmural dispersion of ventricular repolarization. We aimed to determine the presence of cardiac conduction system disorders in patients with systemic arterial hypertension (SAH) who have altered Tpeak-Tend interval of the T wave. METHODS: The 67 patients with SAH were divided into two groups. Those with prolonged (≥ 77 ms) Tpeak-Tend intervals, 21 (31%) patients were in the study group...

BACKGROUND: New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes. AIMS: Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR. METHODS: We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between April 2015 and December 2018. Exclusion criteria included pre-existing LBBB, right BBB, left anterior hemiblock, left posterior hemiblock, wide QRS ≥ 120ms, prior permanent pacemaker (PPM), and nontransfemoral access...

BACKGROUND AND AIM: We investigated the incidence rate of perioperative complications following major vascular surgery, as well as identified the risk factors and preoperative clinical, electrocardiographic and echocardiographic determinants, related to these complications. METHODS: We studied 241 patients with asymptomatic intact abdominal aortic aneurysm (AAA) subjected to open surgical repair, 182 with critical carotid stenosis subjected to endarterectomy (CEA), and 158 with severe symptomatic occlusive peripheral artery disease subjected to aortofemoral bypass (AFB)...

BACKGROUND: Since 2019, coronavirus disease 2019 (COVID-19) has been the leading cause of mortality worldwide. AIMS: To determine independent predictors of mortality in COVID-19, and identify any associations between pulmonary disease severity and cardiac involvement. METHODS: Clinical, laboratory, electrocardiography and computed tomography (CT) imaging data were collected from 389 consecutive patients with COVID-19. Patients were divided into alive and deceased groups...

Conduction disturbances are an important complication of ST-elevation myocardial infarction (STEMI). Conduction disturbances such as fascicular blocks and bundle branch blocks are associated with alteration of QRS morphology and secondary ST-T wave changes that can influence the diagnosis of acute myocardial ischemia. We report an interesting case where a patient presented with inferior wall myocardial infarction (MI), right bundle branch block (RBBB), and left anterior hemiblock (LAHB). We discuss the challenges in diagnosing MI in such patients, including the impact of QRS changes in RBBB and LAHB, their influence on diagnosis of STEMI, and differentiation of combined first-degree AV block and bifascicular block from trifascicular block...

In the background of an accessory pathway (AP), the H-V interval can vary during atrial/coronary sinus pacing, but only with a concomitant change in the QRS morphology and the degree of pre-excitation. In an interesting case of a 62-year-old woman, the H-V interval varied during coronary sinus pacing despite a fixed pre-excitation. This appears to have happened due to infra-Hisian complete atrioventricular dissociation, which resulted from iatrogenic mechanical bumping of the left anterior fascicle in the background of right bundle branch block and left posterior hemiblock...

OBJECTIVES: To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturbances after transcatheter aortic valve implantation (TAVI). METHODS: We retrospectively analyzed the preoperative clinical characteristics, electrocardiograms, contrast-enhanced multidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017. Quantification of calcium volume was performed for each aortic cusp above (aortic valve) and below (left ventricular outflow tract, LVOT) the basal plane...

A continuous discussion regarding the predictors for permanent pacemaker implantation (PPI) following transcatheter aortic valve implantation (TAVI) is ongoing, especially in the era of low and medium risk patients. The aim of this article is to review the data so far regarding the pathophysiology, risk factors, and the indications for permanent pacemaker implantation after TAVI. The factors that contribute to rhythm abnormalities post TAVI can be divided into pre-existing conduction abnormalities, patient-related anatomical factors, and peri-procedural technical factors...

AIM: Amyloidosis is a disease in which amyloid fibrils can be deposited in different cardiac structures, and several electrocardiographic abnormalities can be produced by this phenomenon. The objective of this study was to describe the most common basal electrocardiographic alterations in patients diagnosed with cardiac amyloidosis (CA) and to determine if these abnormalities have an impact on the need of pacemaker. METHODS: This retrospective study included patients who had an established diagnosis of CA [light-chain cardiac amyloidosis (LA-CA) or transthyretin cardiac amyloidosis (TTR-CA)] between January 2013 and March 2021...

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