Development of QT interval evaluation methods in the presence of left bundle branch block
https://doi.org/10.33667/2078-5631-2022-11-13-18
Abstract
The relevance of this development is due to the fact that prolongation or shortening of the QT interval is associated with an increased risk of sudden cardiac death and there is no validated and recognized method to calculate corrected QT interval (QTc) in left bundle branch block (LBBB).
The aim of the study is to develop a method for evaluating the duration of corrected QT interval in patients with LBBB. Electrocardiogams (ECGs) of 43 patients, including 31 women and 12 men, were analyzed. Patients were included in the study if they had ECGs before and after the manifestation of LBBB. At the same time the heart rate (HR) on ECGs should have been 50–90 bpm and the difference in heart rate on ECGs with and without LBBB was no more than 10 bpm. Patients who have suffered myocardial infarction were excluded from the study. Based on the analysis of ECGs before and after the manifestation of LBBB, two methods to calculate QTc have been developed. These methods make it possible to compensate for prolongation of the QT interval caused by enlargement of QRS and demonstrated high accuracy in the calculation of QTc by different formulas, comparing the calculated values for LBBB and values of QTc before the development of LBBB.
1. Linear regression method
Bazett QTclinB = 120,5692 + 0,6315 x QTcBb
Fridericia QTclinF = 130,4425 + 0,6024 x QTcFb
Sagie QTclinS = 125,4726 + 0,6182 x QTcSb
QTcBb. QTcFb. QTcSb – the duration of the corrected values of QT in LBBB according to the formulas of Bazett, Fridericia, Sage, respectively.
2. Method of QT interval compensation for enlargement of QRS in LBBB
QTк = QTb – (QRSb – 100 ms) and the subsequent calculation of QTc by the formulas of Bazett, Fridericia, Sage based on the values of QTк.
About the Authors
Y. E. Teregulov
Kazan State Medical Academy; Kazan State Medical University; Republican Clinical Hospital
Russian Federation
Russian Federation
Teregulov Yuri E., DM Sci (habil.), associate professor, Head of Dept of Functional Diagnostics
Kazan
E. A. Atsel
Kazan State Medical Academy
Russian Federation
Russian Federation
Atsel Evgenia A., DM Sci (habil.), associate professor, professor at Dept of Therapy, Geriatrics and Family Medicine
Kazan
L. F. Salyamova
Kazan State Medical Academy
Russian Federation
Russian Federation
Salyamova Liliya F., assistant at Dept of Functional Diagnostics
Kazan
F. R. Chuvashaeva
Kazan State Medical Academy; Republican Clinical Hospital
Russian Federation
Russian Federation
Chuvashayeva Farida R., assistant at Dept of Functional Diagnostics
Kazan
A. Y. Teregulov
Kazan (Volga region) Federal University; Republican Clinical Hospital
Russian Federation
Russian Federation
Teregulov Andrey Yu., PhD Med, associate professor at Dept of Surgical Diseases of Postgraduate Education, Institute of Fundamental Medicine and Biology
Kazan
I. I. Miliutina
Kazan State Medical Academy
Russian Federation
Russian Federation
Milyutina Irina I., resident at Dept of Functional Diagnostics
Kazan
References
1. Francia P., Balla C., Paneni F., Volpe M. Left Bundle-Branch Block – Pathophysiology, Prognosis, and Clinical. Clinical Cardiology. 2007; (30): 110–115. https://doi.org/10.1002/clc.20034
2. Zannad F., Huvelle E., Dickstein K. et al. Left bundle branch block as a risk factor for progression to heart failure//Eur J Heart Failure 2007; 9:7–14.
3. Yanushkevichus Z.I., Bredikis Yu. Yu., Lukoshevichute A.I., Zebela P.V. Rhythm and conduction disorders of the heart. Moscow: Medicine. 1984: 288 p.
4. Orlov V.N. Guide to electrocardiography – 9th ed., Rev. Moscow: OOO Medical Information Agency. 2017: 560 p.
5. Silvia P.G., Blomström-Lundqvist C., Mazzanti A., Bloma N., Borggrefe M., Camm J., Elliott P.M., Fitzsimons D., Hatala R., Hindricks G., Kirchhof P., Kjeldsen K., Kuck K.-H., Hernandez A., Nikolaou N., Norekvål T.M., Spaulding C., Van Veldhuisen D.J. ESC guidelines for the treatment of patients with ventricular arrhythmias and the prevention of sudden cardiac death 2015. Russian Journal of Cardiology. 2016; (7 (135)): 82. https://doi.org/10.15829/1560–4071–2016–7–5–86
6. Wilson F.N., Kossmann C. E., Burch G., Goldberger E., Graybiel A., Hecht H., Johnston F., Lepeschkin E., Myers G.B. Recommendations for Standardization of Electrocardiographic and Vectorcardiographic Leads. Circulation. 1954; (10): 364–373. https://doi.org/10.1161/01.CIR.10.4.564
7. Nielsen J.B. Risk prediction of cardiovascular death based on the QTc interval: evaluating age and gender differences in a large primary care population. European Heart Journal. 2014; (35): 1335–1344. https://doi.org/10.1093/eurheartj/ehu081
8. Gaita F., Giustetto C., Bianchi F., Wolpert C., Schimpf R., Riccardi R., Grossi S., Richiardi E., Borggrefe M. Short QT Syndrome: a familial cause of sudden death. Circulation. 2003; (108): 965–970. https://doi.org/10.1161/01.CIR.0000085071.28695.C4
9. Garipova A.F., Oslopov V.N., Saifutdinov R.G., Teregulov Yu.E. Long QT in the practice of a cardiologist and endocrinologist: a monograph. Under the editorship of prof. V.N. Oslopov. Kazan: MedDoc publishing house. 2016: 260 p.
10. Isbister G.K., Page C.B. Drug induced QT prolongation: the measurement and assessment of the QT interval in clinical practice. British journal of clinical pharmacology. 2013; (76): 48–57. https://doi.org/10.1111/bcp.12040
11. Bazett H.C. An analysis of the time-relations of electrocardiograms. Heart. 1920; (7): 353–370. https://doi.org/10.1111/j.1542–474X.1997.tb00325.x
12. Fridericia L.S. The duration of systole in the electrocardiogram of normal subjects and of patients with heart disease. Acta Medica Scandinavica. 1920; (53): 469–486. https://doi.org/10.1046/j.1542–474X.2003.08413.x
13. Sagie A., Larson M.G., Goldberg R.J., Bengston J.R., Levy D. An improved method for adjusting the QT interval for heart rate (the Framingham Heart Study). The American journal of cardiology. 1992; (70 (7)): 797–801. https://doi.org/10.1016/0002–9149(92)90562-D
14. Teregulov Yu.E., Salyamova L. F., Gizatullina A. F., Maksumova N.V. Assessment of the QT interval during the exercise test. Practical medicine. 2018; (1(112)): 30–36.
15. Rautaharju P.M., Zhang Z.M. Linearly scaled, rate-invariant normal limits for QT interval: eight decades of incorrect application of power functions // J. Cardiovasc. Electrophysiol.– 2002.– Vol. 13.– Р. 1211–1218.
16. Rautaharju, P.M., Zhang, Z.M., Prineas, R., Heiss, G. Assessment of prolonged QT and JT intervals in ventricular conduction defects. The American Journal of Cardiology. 2004; (93): 1017–1021. https://doi.org/10.1016/j.amjcard.2003.12.055
17. Bogossian H, Frommeyer G, Ninios I., Hasan F., Nguyen O.S., Karosiene Z., Mijic D., Kloppe A., Suleiman H., Bandorski D., Seyfarth M., Lemke B., Eckardt L., Zarse M. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm. 2014; (11(12)): 2273–2277. https://doi.org/10.1016/j.hrthm.2014.08.026.
18. Bogossian H., Frommeyer G., Ninios I., Pechlivanidou E., Hasan F., Nguyen Q.S., Mijić D., Kloppe A., Karosiene Z., Margkarian A., Bandorski D., Schultes D., Erkapic D., Seyfarth M., Lemke B., Eckardt L., Zarse M. A new experimentally validated formula to calculate the QT interval in the presence of left bundle branch block holds true in the clinical setting. Annalls of Noninvasive Electrocardiology. 2017; (22 (2)): e12393. https://doi.org/10/1111/anec.12393
19. Wang B, Zhang L, Xia Y. “Cutting off half of QRS duration can cause overcorrection of QT interval in left bundle branch block.” Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc vol. 22,4 (2017): e12458. doi:10.1111/anec.12458
Review
For citations:
Teregulov Y.E., Atsel E.A., Salyamova L.F., Chuvashaeva F.R., Teregulov A.Y., Miliutina I.I. Development of QT interval evaluation methods in the presence of left bundle branch block. Medical alphabet. 2022;(11):13-18. (In Russ.) https://doi.org/10.33667/2078-5631-2022-11-13-18
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