Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1970 May;32(3):386–392. doi: 10.1136/hrt.32.3.386

Vectorcardiographic study of QRS loop in patients with left superior axis deviation and right bundle-branch block

H Kulbertus 1, P Collignon 1, L Humblet 1
PMCID: PMC487338  PMID: 4246191

Abstract

Thirty-four elderly patients with right bundle-branch block and left axis deviation were studied vectorcardiographically utilizing the McFee-Parungao system. Atherosclerosis, arterial hypertension, angina pectoris, cardiac enlargement, and heart failure were common clinical features in this series. Moreover, intermittent advanced degree of atrioventricular block was present in 10 out of the 34 patients.

The vectorcardiograms might be readily classified into two basic patterns, types A and B. In type A (19 cases), the frontal plane loop was open-faced. The initial vectors were directed anteriorly, inferiorly, and to the right. The mid-temporal vectors were located in the left postero-superior octant, and the late portion of the loop was inscribed anteriorly to the right with conspicuous conduction delay. Those vectorcardiographic features associate the characteristic patterns of left superior intraventricular block with complete right bundle-branch block.

The type B vectorcardiograms (15 cases) demonstrated anterior clockwise loops in the horizontal plane and superior counterclockwise loops in the frontal plane. From a review of the published reports and from personal data, the authors assume that both vectorcardiographic patterns may result from an abnormal spread of excitation resulting from bilateral branch conduction disturbances.

Full text

PDF
386

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Castellanos A., Jr, Lemberg L., Ioannides G., Salhanick L. The vectorcardiogram in right bundle branch block coexisting with left ventricular focal block. Am J Cardiol. 1966 Nov;18(5):705–712. doi: 10.1016/0002-9149(66)90088-9. [DOI] [PubMed] [Google Scholar]
  2. Cohen S. I., Lau S. H., Stein E., Young M. W., Damato A. N. Variations of aberrant ventricular conduction in man: evidence of isolated and combined block within the specialized conduction system. An electrocardiographic and vectorcardiographic study. Circulation. 1968 Nov;38(5):899–916. doi: 10.1161/01.cir.38.5.899. [DOI] [PubMed] [Google Scholar]
  3. HUGENHOLTZ P. G., FORKNER C. E., Jr, LEVINE H. D. A clinical appraisal of the vectorcardiogram in myocardial infarction. II. The Frank system. Circulation. 1961 Oct;24:825–850. doi: 10.1161/01.cir.24.4.825. [DOI] [PubMed] [Google Scholar]
  4. Harris A., Davies M., Redwood D., Leatham A., Siddons H. Aetiology of chronic heart block. A clinico-pathological correlation in 65 cases. Br Heart J. 1969 Mar;31(2):206–218. doi: 10.1136/hrt.31.2.206. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Kulbertus H., Collignon P. Association of right bundle-branch block with left superior or inferior intraventricular block. Its relation to complete heart block and Adams-Stokes syndrome. Br Heart J. 1969 Jul;31(4):435–440. doi: 10.1136/hrt.31.4.435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kulbertus H., Collignon P., Humblet L. Vectorcardiographic study of the QRS loop in patients with left anterior focal block. Am Heart J. 1970 Mar;79(3):293–304. doi: 10.1016/0002-8703(70)90417-5. [DOI] [PubMed] [Google Scholar]
  7. LEPESCHKIN E. THE ELECTROCARDIOGRAPHIC DIAGNOSIS OF BILATERAL BUNDLE BRANCH BLOCK IN RELATION TO HEART BLOCK. Prog Cardiovasc Dis. 1964 Mar;6:445–471. doi: 10.1016/s0033-0620(64)80002-5. [DOI] [PubMed] [Google Scholar]
  8. Lasser R. P., Haft J. I., Friedberg C. K. Relationship of right bundle-branch block and marked left axis deviation (with left parietal or peri-infarction block) to complete heart block and syncope. Circulation. 1968 Mar;37(3):429–437. doi: 10.1161/01.cir.37.3.429. [DOI] [PubMed] [Google Scholar]
  9. McClenahan J. B. The significance of pronounced left axis deviation in the presence of right bundle branch block. Calif Med. 1969 May;110(5):378–382. [PMC free article] [PubMed] [Google Scholar]
  10. Rosenbaum M. B. Types of right bundles branch block and their clinical significance. J Electrocardiol. 1968;1(2):221–232. doi: 10.1016/s0022-0736(68)80031-7. [DOI] [PubMed] [Google Scholar]
  11. Rothfeld E. L., Zucker I. R., Tiu R., Parsonnet V. The electrocardiographic syndrome of superior axis and right bundle branch block. Dis Chest. 1969 Apr;55(4):306–309. doi: 10.1378/chest.55.4.306. [DOI] [PubMed] [Google Scholar]
  12. Saltzman P., Linn H., Pick A. Right bundle-branch block with left axis deviation. Br Heart J. 1966 Sep;28(5):703–708. doi: 10.1136/hrt.28.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Slama R., Marneffe H., Gourgon R., Motte G. Aspect du ventriculogramme en rythme sinusal chez les malades atteints de blocs auriculoventriculaires chroniques. Etude générale et cas particulièrs. Mal Cardiovasc. 1966;7(3):353–368. [PubMed] [Google Scholar]
  14. Testoni F., Narbone N. B., Tommaselli A. Aspetti vettocardiografici nei blocchi focali sinistri con elettrocardiogramma di tipo RI-SII-SIII. Mal Cardiovasc. 1968;9(3):379–402. [PubMed] [Google Scholar]
  15. UNGER P. N., LESSER M. E., KUGEL V. H., LEV M. The concept of masquerading bundle-branch block; an electrocardiographic-pathologic correlation. Circulation. 1958 Mar;17(3):397–409. doi: 10.1161/01.cir.17.3.397. [DOI] [PubMed] [Google Scholar]
  16. WALSH T. J., TIONGSON P. M., STODDARD E. A., MASSIE E. The vectorcardiographic QRS-sE-loop findings in inferoposterior myocardial infarction. Am Heart J. 1962 Apr;63:516–527. doi: 10.1016/0002-8703(62)90309-5. [DOI] [PubMed] [Google Scholar]
  17. Watt T. B., Jr, Freud G. E., Durrer D., Pruitt R. D. Left anterior arborization block combined with right bundle branch block in canine and primate hearts. An electrocardiographic study. Circ Res. 1968 Jan;22(1):57–63. doi: 10.1161/01.res.22.1.57. [DOI] [PubMed] [Google Scholar]
  18. Watt T. B., Jr, Pruitt R. D. Character, cause, and consequence of combined left axis deviation and right bundle branch block in human electrocardiograms. Am Heart J. 1969 Apr;77(4):460–465. doi: 10.1016/0002-8703(69)90154-9. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES