Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2017, 26(1):25-32

ECG signs of left ventricular hypertrophy: Results of computer simulations

Bachárová L1, 2, Szathmáry V3, Mateašík A1
1 Medzinárodné laserové centrum v Bratislave
2 Ústav patologickej fyziológie LF UK v Bratislave
3 Ústav normálnej a patologickej fyziológie SAV v Bratislave, Slovenská republika

The classical paradigm of the left ventricular hypertrophy (LVH) postulates the increased electrical dominance of the left ventricle, i.e. the increased QRS amplitude in leads that record resultant electrical forces directed leftward, downward and posteriorly. However, the ECG criteria based on this paradigm are characteristic by low sensitivity and questionable specificity. The International Working Group on the ECG Diagnosis of Left ventricular Hypertrophy at the Journal of electrocardiology aims to re-evaluating and re-defining the role of ECG in left ventricular diagnosis. In this paper we present results of simulation studies that create basis for the change in paradigm of the ECG diagnosis of LVH. The simulation studies using computer modeling have shown that left ventricular mass is not the main determinant of the QRS complex changes, but the main factor is the altered electrical properties of myocardium associated with the electrical remodeling of the hypertrophied myocardium. The altered electrical properties of the hypertrophied tissue change the sequence of the activation front and its deformation, leading consequently to changes in QRS morphology. Similar changes have been documented also in other cardiac pathology, e.g. ischemic hear disease, what is consistent with results of computer simulations as well as with clinical experience. The supporting evidence for the change in the paradigm creates also a conceptual link with the electrophysiological mechanisms in the pathogenesis of arrhythmias.

Keywords: ECG; left ventricular hypertrophy; diagnostics paradigm; decelerated procedure of electrically ventricular activation; computational simulations

Published: January 1, 2017  Show citation

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Bachárová L, Szathmáry V, Mateašík A. ECG signs of left ventricular hypertrophy: Results of computer simulations. Cardiology Letters. 2017;26(1):25-32.
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