Criteria for right bundle branch block based on three-dimensional vectorcardiography. Possibilities of differential diagnostics

Relevance. Right bundle branch block (RBBB) has characteristic manifestations on an ECG, however, in clinical practice, when combined with another pathology – myocardial infarction, arrhythmogenic right ventricular dysplasia, combined damage to the conduction system, etc. difficulties may arise in interpretation.

The purpose of the study. Development of RBBB criteria based on three-dimensional vector analysis with an assessment of the rate of formation of a spatial vector loop.

Material and methods. The main group included 64 patients with BPH, including 42 men and 22 women, with an average age of 31.1±9.62 (M±σ) years. Patients with complete and incomplete RBBB were identified according to the accepted ECG criteria. The control group included 80 healthy patients with an average age of 31.5±6.3 (M±σ) years, 54 of them women and 26 men. Synchronous recording of 12 standard leads was performed in all patients, followed by reconstruction of a three-dimensional ECG using the EasyECG Rest ATES Medica software (Russia).

The results of the study and conclusions. The criteria of RBBB based on three-dimensional ECG with an analysis of the spatial vector loop tracing rate have been determined, which remain effective in combination with left anterior fascicular block, and also allow for differential diagnosis with myocardial infarction, with epsilon wave in arrhythmogenic right ventricular dysplasia and other diseases of the cardiovascular system.

1. Eriksson P., Hansson P.O., Eriksson H., Dellborg M. Bundle-branch block in a general male population: the study of men born 1913. Circulation. 1998;98(22):2494–2500. doi: 10.1161/01.CIR.98.22.2494.

2. Bussink B.E., Holst A.G., Jespersen L., Deckers J.W., Jensen G.B., 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(2):138–146. doi: 10.1093/eurheartj/ehs291

3. Zhang Z.M., Rautaharju P.M., Soliman E.Z., et al. Mortality risk associated with bundle branch blocks and related repolarization abnormalities (from the Women’s Health Initiative [WHI]). Am. J. Cardiol. 2012;110(10):1489–1495. doi: 10.1016/j.amjcard.2012.06.060.

4. Badheka A.O., Singh V., Patel N.J., et al. QRS duration on electrocardiography and cardiovascular mortality (from the National Health and Nutrition Examination Survey-III). Am. J. Cardiol. 2013;112(5):671–677. doi: 10.1016/j.amjcard.2013.04.040.

5. Ikeda T. Right Bundle Branch Block: Current Considerations. Curr Cardiol Rev. 2021;17(1):24-30. doi: 10.2174/1573403X16666200708111553. PMID: 32640959; PMCID: PMC8142372.

6. Hesse B., Diaz L.A., Snader C.E., Blackstone E.H., Lauer M.S. Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing. Am. J. Med. 2001;110(4):253–259. doi: 10.1016/S0002-9343(00)00713-0.

7. Freedman R.A., Alderman E.L., Sheffield L.T., Saporito M., Fisher L.D. Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance. J. Am. Coll. Cardiol. 1987;10(1):73–80. doi: 10.1016/S0735-1097(87)80162-6.

8. Barsheshet A., Goldenberg I., Garty M., et al. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am. J. Cardiol. 2011;107(4):540–544. doi: 10.1016/j.amjcard.2010.10.007.

9. Rasmussen P.V., Skov M.W., Ghouse J., et al. Clinical implications of electrocardiographic bundle branch block in primary care. Heart. 2019;105(15):1160–1167. doi: 10.1136/heartjnl-2018-314295.

10. Xiong Y., Wang L., Liu W., Hankey G.J., Xu B., Wang S. The prognostic significance of right bundle branch block: A meta-analysis of prospective cohort studies. Clin. Cardiol. 2015;38(10):604–613. doi: 10.1002/clc.22454.

11. Orlov V.N. Manual of electrocardiography 9th ed., ispr. – Moscow: LLC «Medical Information Agency», 2017. 560 p.

12. Kushakovsky M.S., Grishkin Yu.N. Cardiac arrhythmias (Heart rhythm disorders and conduction disorders. Causes, mechanisms, electrocardiographic and electrophysiological diagnostics, clinic, treatment): A guide for doctors. – 4th ed., corr. and exp. – St. Petersburg, LLC «Foliant Publishing House», 2014. – 720 p.

13. De Luna A.B. Guidelines for clinical ECG: Translated from English – M.: Medicine, 1993. – 704 p.

14. Hait G.Ya. Fundamentals of diagnostics of clinical electrocardiology. – M.: ANMI, 2003. – 329 p.

15. Tabib A., Loire R., Chalabreysse L., Meyronnet D., Miras A., Malicier D. et al. Circumstances of death and gross and microscopic observations in series of 200 cases of sudden death associated with arrhythmogenic right ventricular cardiomyopathy and/or dysplasia. Circulation. 2003; 108 (24): 3000 – 5.

16. Kushakovsky M.S., Zhuravleva N.B. Arrhythmias and heart block: (atlas of electrocardiograms) – 2nd edition, stereotypical. – L.: Medicine, 1983. – 340 p.

17. Bialostosky D., Medrano G. A., Munoz L., Contreras R. Vectorcardiographic study and anatomic observations in 21 cases of Ebstein’s malformations. – Am. J. Cardiol., 1972, 30, 354.

18. De Artaza M., Aznar J., Bayes de Luna A., Cosin J. et al. Criterios VCG: Coclusiones Comite Hispano – Luso. – Rev. Esp. Cardiol,., 1982, 35, 205.

19. Titomir L.I., Rutkai–Nedetsky I. Analysis of an orthogonal electrocardiogram. M.: Nauka, 1990. 198 p.

20. Sedaghat G, Ghafoori E, Waks JW, Kabir MM, Shvilkin A, Josephson ME, Tereshchenko LG. Quantitative Assessment of Vectorcardiographic Loop Morphology. J Electrocardiol. 2016 Mar-Apr;49(2):154-63. doi: 10.1016/j.jelectrocard.2015.12.014.

21. Teregulov Yu.E., Atsel E.A., Ganieva S.F., Teregulova E.T., Maksimova M.S., Teregulov A.Yu., Kamaletdinova Z.A. Three-dimensional vector ECG analysis in the diagnosis of the left anterior fascicular block. Medical alphabet. 2023;1(15):28-34. https://doi.org/10.33667/2078-5631-2023-15-28-34.

22. Tereshchenko, L. G. (2018). Left anterior fascicular block: The need for a re-appraisal. International Journal of Cardiology, 269, 31-32. https://doi.org/10.1016/j.ijcard.2018.07.079.

23. Salyamova L.F. Assessment of electrophysiological mechanisms of ventricular ectopia in arrhythmogenic right ventricular dysplasia. Medical alphabet. 2024;(22): 20–27. https://doi.org/10.33667/20785631-2024-22-20-27