Key result
Premature ventricular beats with a right bundle branch block pattern deteriorated into ventricular tachycardia significantly more frequently (24.8%) than those with a left bundle branch block pattern (11.7%).
Why the study?
Does the QRS morphology of premature ventricular beats predict progression to ventricular tachycardia in acute myocardial ischemia?
Observational (n=18)
No
Does the QRS morphology of premature ventricular beats predict progression to ventricular tachycardia in acute myocardial ischemia?
During acute myocardial ischemia, premature ventricular beats with an RBBB pattern are more likely to progress to ventricular tachycardia than those with an LBBB pattern, though morphology alone is insufficient to rule out VT risk.
Answers are grounded in this paper and cite their sources.
May warrant vigilance for RBBB-pattern PVCs in acute ischemia; hypothesis-generating and should not yet change practice.
The features of ventricular arrhythmia in coronary spasm induced by ergonovine were examined to elucidate the characteristics of ventricular arrhythmia in acute myocardial ischemia. The coupling intervals and configurations of the QRS wave of the premature ventricular beats (PVBs) were extremely variable, even in the same individual and at the closer time phases. The prematurity index (R-R'/QT) of PVBs with the right bundle branch block (RBBB) pattern was significantly smaller than with the left bundle branch block (LBBB) pattern. The vulnerability index (R-RX QT/R-R') of PVBs with the RBBB pattern was significantly larger than with the LBBB pattern. The incidence of PVBs with the RBBB pattern (50.4%) was slightly larger than with the LBBB pattern (40.5%). PVBs deteriorated into ventricular tachycardias (VTs) in 29 (24.8%) of 117 cases with the RBBB pattern and in 11 (11.7%) out of 94 cases with the LBBB pattern. Thus, PVBs with the RBBB pattern were more likely to progress to VT than with the LBBB pattern. But it is difficult to assess the clinical significance of PVBs from their QRS morphology alone, because 11 (27.5%) of 40 cases of VT were initiated by PVBs with the LBBB pattern.
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Fujino et al. (1985) conducted an observational in Acute myocardial ischemia (ergonovine-induced coronary spasm) (n=18). Right bundle branch block (RBBB) pattern premature ventricular beats vs. Left bundle branch block (LBBB) pattern premature ventricular beats was evaluated on Deterioration of premature ventricular beats into ventricular tachycardia (p=<0.01). Premature ventricular beats with a right bundle branch block pattern deteriorated into ventricular tachycardia significantly more frequently (24.8%) than those with a left bundle branch block pattern (11.7%).
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