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Sample records for bundle-branch block

  1. Bundle Branch Block

    Science.gov (United States)

    ... 2015. Bundle branch block Symptoms & causes Diagnosis & treatment Advertisement Mayo Clinic does not endorse companies or products. ... a Job Site Map About This Site Twitter Facebook Google YouTube Pinterest Mayo Clinic is a not- ...

  2. Right bundle branch block

    DEFF Research Database (Denmark)

    Bussink, Barbara E; Holst, Anders Gaarsdal; Jespersen, Lasse

    2013-01-01

    AimsTo determine the prevalence, predictors of newly acquired, and the prognostic value of right bundle branch block (RBBB) and incomplete RBBB (IRBBB) on a resting 12-lead electrocardiogram in men and women from the general population.Methods and resultsWe followed 18 441 participants included.......5%/2.3% in women, P Right bundle branch block was associated with significantly...... increased all-cause and cardiovascular mortality in both genders with age-adjusted hazard ratios (HR) of 1.31 [95% confidence interval (CI), 1.11-1.54] and 1.87 (95% CI, 1.48-2.36) in the gender pooled analysis with little attenuation after multiple adjustment. Right bundle branch block was associated...

  3. Left bundle-branch block

    DEFF Research Database (Denmark)

    Risum, Niels; Strauss, David; Sogaard, Peter

    2013-01-01

    The relationship between myocardial electrical activation by electrocardiogram (ECG) and mechanical contraction by echocardiography in left bundle-branch block (LBBB) has never been clearly demonstrated. New strict criteria for LBBB based on a fundamental understanding of physiology have recently...

  4. Axis deviation without left bundle branch block.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Mancuso, Antonia

    2010-04-15

    It has been rarely reported changing axis deviation in the presence of left bundle branch block also during atrial fibrillation and with acute myocardial infarction too. It has also been rarely reported changing axis deviation with changing bundle branch block with onset of atrial fibrillation during acute myocardial infarction. We present a case of axis deviation without left bundle branch block and without atrial fibrillation and acute myocardial infarction in a 65-year-old Italian man. To our knowledge, this is the first report of axis deviation without left bundle branch block and without atrial fibrillation and acute myocardial infarction. Copyright 2008 Elsevier Ireland Ltd. All rights reserved.

  5. Masquerading bundle branch block: a variety of right bundle branch block with left anterior fascicular block.

    Science.gov (United States)

    Elizari, Marcelo V; Baranchuk, Adrian; Chiale, Pablo A

    2013-01-01

    The so-called 'masquerading' type of right bundle branch block is caused by the simultaneous presence of a high-degree left anterior fascicular block often accompanied with severe left ventricular enlargement and/or fibrotic block in the anterolateral wall of the left ventricle. These conditions tend to reorient the terminal electrical forces of the QRS complex towards the left and upwards, in such a way that the characteristic slurred S wave in lead I becomes smaller or even disappears. In many cases of standard masquerading right bundle branch block, a small Q wave in lead I is present due to the initial forces of the left anterior fascicular block, which are oriented rightwards and inferiorly. However, in some cases, the Q wave in lead I also vanishes, and the mimicking of a left bundle branch block becomes perfect in standard leads. This is commonly associated with an inferior myocardial infarction or severe inferior fibrosis in cardiomyopathies. The typical QRS changes of right bundle branch block may eventually be concealed even in the right precordial leads; under such circumstances, the ECG diagnosis may be mistaken and the right bundle branch block totally missed. The masquerading right bundle branch block carries a poor prognosis, since it always implies the presence of a severe underlying heart disease.

  6. A case of 'Masquerading' bundle branch block: a forgotten concept.

    Science.gov (United States)

    Choudhary, Dinesh; Namboodiri, Narayanan; Tharakan, Jaganmohan A

    2014-01-01

    'Masquerading' bundle branch block (right bundle branch block in the precordial leads with left bundle branch block in frontal leads and left axis deviation) is seen most commonly with coronary artery disease and hypertension. No definite explanation is available so far for these changes. We are presenting a case of rare congenital intranuclear inclusion myopathy with congestive heart failure and 'Masquerading' bundle branch block in ECG. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  7. Baseline left bundle branch block with right bundle branch escape complexes in a patient with coronary artery disease, presents like an alternating bundle branch block: a case report

    Science.gov (United States)

    Bhimaraj, Arvind; Abusin, Salaheldin; Margeta, Bosko

    2008-01-01

    Alternating bundle branch block (ABBB) is a less commonly encountered phenomenon with the advent of re-perfusion therapy for acute myocardial infarction. ECGs simulating the appearance of an ABBB need to be carefully analysed. We present an ECG showing a baseline Left Bundle Branch Block(LBBB) progressing to a high grade AV block with escape complexes having a Right Bundle Branch Block (RBBB) morphology. Such an ECG can be mistaken for an ABBB if not analysed carefully. PMID:19116014

  8. [Bundle-branch block depending on the heart rate].

    Science.gov (United States)

    Apostolov, L

    1975-01-01

    Five patients are reported, admitted to the hospital, with diseases predominantly of the cardio-vascular system. During the electrocardiographic examinations bundle branch block was established, depending on heart rate. It fluctuated within the physiological limits from 50 to 90/min. In three of the patients, the bundle branch block appeared with the quickening of the heart rate (tachycardia-depending bundle branch block) and in two of the patients--the bundle branch block appeared during the slowing down of the heart action and disappeared with its quickening (bradicardia-depending bundle branch block). A brief literature review is presented and attention is paid to the possible diagnostic errors and the treatment mode of those patients with cardiac tonic and antiarrhythmic medicaments.

  9. Transient Left Bundle Branch Block due to Severe Hyperkalemia.

    Science.gov (United States)

    Kumar, Kishore; Biyyam, Madhavi; Singh, Amandeep; Bajantri, Bharat; Tariq, Hassan; Nayudu, Suresh Kumar; Chilimuri, Sridhar

    2017-04-01

    Hyperkalemia is a potentially life-threatening electrolyte imbalance that can lead to sudden death from cardiac arrhythmias and asystole. We present a case of transient left bundle branch block pattern on an electrocardiogram (ECG) secondary to hyperkalemia in a patient with history of end-stage renal disease. A 52-year-old man presented to the emergency room (ER) with chief complaints of weakness and lethargy after missing his regularly scheduled session of hemodialysis. A 12-lead ECG in the ER showed sinus tachycardia at 118 beats/min, wide QRS complexes, peaked T waves and left bundle branch block-like pattern. The initial basic metabolic panel revealed a serum potassium level of 8.8 mEq/L. Subsequently, the patient underwent emergent hemodialysis. Serum chemistry after hemodialysis showed improvement in serum potassium to 4.3 mEq/L. Repeat ECG performed after correcting potassium showed dissolution of left bundle branch block finding.

  10. A quantitative histopathological study of right bundle branch block complicating acute anteroseptal myocardial infarction.

    OpenAIRE

    Okabe, M; Fukuda, K; Nakashima, Y; Hiroki, T; Arakawa, K; Kikuchi, M

    1991-01-01

    The aim of the present study was to evaluate whether necrosis of the right bundle branch is responsible for development of right bundle branch block in acute myocardial infarction. Twenty patients with acute anteroseptal myocardial infarction were studied--10 with right bundle branch block (group A) and 10 without (group B)--to evaluate by serial sectioning the pathological extent of myocardial infarction surrounding the right bundle branch and also that of right bundle branch necrosis. Myoca...

  11. MYOCARDIAL DEFORMATION AND COMPLETE LEFT BUNDLE BRANCH BLOCK

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2015-12-01

    Full Text Available Tissue Doppler imaging is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular systolic and diastolic function. Over the last 10 years, myocardial deformation imaging has become possible initially with tissue Doppler , and more recently with myocardial speckle-tracking using 2D echocardiography. Unlike simple tissue velocity measurements, deformation measurements are specific for the region of interest. Strain rate or strain measurements have been used as sensitive indicators for subclinical diseases, and it is the most widely used tool to assess mechanical dyssynchrony. Left bundle branch block is a frequent, etiologically heterogeneous, clinically hostile and diagnostically challenging entity. About 2% of patients underwent cardiac stress testing show stable or intermittent left bundle branch block. Presence of left bundle branch block is associated with a lower and slower diastolic coronary flow velocity especially during hyperemia. Stress echocardiography is the best option for the diagnosis of ischemic heart disease, albeit specificity and sensitivity reduce in patients with left bundle branch block in the territory of left anterior descending artery in presence of initial septum dyskinesia.

  12. A case of ‘Masquerading’ bundle branch block: A forgotten concept

    OpenAIRE

    Dinesh Choudhary; Narayanan Namboodiri; Jaganmohan A. Tharakan

    2014-01-01

    ‘Masquerading’ bundle branch block (right bundle branch block in the precordial leads with left bundle branch block in frontal leads and left axis deviation) is seen most commonly with coronary artery disease and hypertension. No definite explanation is available so far for these changes. We are presenting a case of rare congenital intranuclear inclusion myopathy with congestive heart failure and ‘Masquerading’ bundle branch block in ECG.

  13. Structural Causes of Right Bundle Branch Block?Time for a Closer Look?

    OpenAIRE

    Ker, James

    2010-01-01

    Right bundle branch block is an electrocardiographic phenomenon with specific criteria. Currently, two specific forms of right bundle branch block are acknowledged, a proximal and a distal variant. A vast array of pathologies can cause proximal, distal or even combined forms of right bundle branch block. In this study it is suggested that a third type of right bundle branch block exist: one caused by a subaortic muscular tendon in the left ventricle, leading to an increased velocity of conduc...

  14. Left Bundle Branch Block and Complete Heart Block Complicating Inferior Myocardial Infarction.

    Science.gov (United States)

    Gruber, Jillian S; Stair, Brad; Aktas, Mehmet; Bravo-Jaimes, Katia

    2017-01-01

    Left bundle branch block following inferior myocardial infarction remains uncommon and scarcely reported in the literature. We describe a rare presentation of a 58-year-old male patient who developed left bundle branch block and third degree atrioventricular block after inferior myocardial infarction requiring permanent pacemaker placement. Pathophysiology, impact on mortality, and management options are discussed. © 2016 Wiley Periodicals, Inc.

  15. Isolated Left Bundle Branch Block in a Toddler

    Directory of Open Access Journals (Sweden)

    Hitesh Agrawal

    2014-01-01

    Full Text Available Left bundle branch block (LBBB usually occurs as a postoperative complication from surgical correction of congenital heart disease and can be associated with hypertensive heart disease, coronary artery disease, myocarditis, and aortic valvular disease. Although isolated LBBB is a conduction abnormality found in some healthy adults, it has not been reported in pediatric population. We report a 2-year-old, healthy African American female who was incidentally discovered to have isolated LBBB that has persisted in a follow-up of 3 years.

  16. Isolated Left Bundle Branch Block in a Toddler

    Science.gov (United States)

    Zimmerman, Frank; Naheed, Zahra

    2014-01-01

    Left bundle branch block (LBBB) usually occurs as a postoperative complication from surgical correction of congenital heart disease and can be associated with hypertensive heart disease, coronary artery disease, myocarditis, and aortic valvular disease. Although isolated LBBB is a conduction abnormality found in some healthy adults, it has not been reported in pediatric population. We report a 2-year-old, healthy African American female who was incidentally discovered to have isolated LBBB that has persisted in a follow-up of 3 years. PMID:24963416

  17. Recurrent extensive anterior myocardial infarction with left and right bundle branch block.

    Science.gov (United States)

    Jiang, Hexi; Chang, Qinghua; Zhang, Yingjie; Liu, Renguang

    2017-10-15

    The diagnosis of myocardial infarction with left bundle branch block is difficult. We report a case of 56-year-old man with old extensive anterior myocardial infarction and left bundle branch block (masked each other). The recurrent myocardial infarction indicated right bundle branch block and first-degree atrioventricular block, making a clear diagnosis of complicated and interesting ECG. © 2017 Wiley Periodicals, Inc.

  18. Harder Roads to Trek? Paradoxical Slowing of an Atrioventricular Reentrant Tachycardia With Contralateral Bundle Branch Block.

    Science.gov (United States)

    Divakara Menon, Syamkumar M; Ayati, Maryam; Healey, Jeff S

    2017-04-01

    Slowing of the tachycardia with increase in cycle length and increase in VA time with ipsilateral bundle branch block is a characteristic feature of accessory pathway mediated AVRT. Contralateral bundle branch block has no effect on the tachycardia as it is not a part of the tachycardia circuit. We present an interesting phenomenon in which contralateral bundle branch block resulted in tachycardia slowing in a case of WPW syndrome. © 2016 Wiley Periodicals, Inc.

  19. Left bundle-branch block with right axis deviation--a unique aberrancy during supraventricular tachycardia.

    Science.gov (United States)

    Lokhandwala, Yash; Panicker, Gopi Krishna; Shah, Mandar; Wellens, Hein J J

    2009-01-01

    A tachycardia with left bundle-branch block morphology and right axis deviation points to the diagnosis of ventricular tachycardia. Conversely, any supraventricular tachycardia with left bundle-branch block is typically associated with a normal or leftward QRS axis. We present the case of a 34-year-old man showing atrioventricular nodal reentrant tachycardia with left bundle-branch block/right axis deviation as an exception to this rule.

  20. Rare Manifestation of Digoxin Toxicity: Right Bundle Branch Block

    Science.gov (United States)

    Gill, Dalvir; Zaidi, Samana

    2016-01-01

    A 76-year-old female, with medical history significant for systolic congestive heart failure, who presented to the emergency department with lethargy and abdominal pain with diarrhea for the past 3 weeks. Due to hypotension, the patient received multiple boluses of isotonic saline and was started on norepinephrine. Laboratories were significant for severe digoxin toxicity (29 ng/mL), in setting of acute kidney injury. Electrocardiogram (EKG) revealed a new right bundle branch block (RBBB). She was given Digibind and her repeat digoxin level was 20 ng/mL. Repeat EKG showed resolved RBBB. This case identifies that patients with digoxin toxicity are at risk for RBBB. This is a rare finding and is not commonly recognized. Emergency medicine physicians are often the first to encounter patients with digoxin toxicity and need to be aware of such EKG findings. PMID:28104974

  1. Intermittent left bundle branch block caused by coronary vasospasm

    Science.gov (United States)

    Alhaji, Mohammad

    2013-01-01

    Intermittent left bundle branch block (LBBB) has been reported in the literature following certain conditions such as cardiac blunt trauma, myocardial infarction (MI) or exercise induced LBBB. In the majority of cases, the patients usually have underlying coronary arteries disease. LBBB often prevents the electrocardiographic diagnosis of acute MI; therefore, new LBBB in the setting of chest pain is usually treated as transmural MI. We describe a case of patient who presented with intermittent LBBB associated with chest pain, and subsequently the patient was taken to the catheterization laboratory for emergency coronary angiogram, which revealed 80% spasm in left anterior descending artery, which was totally relieved by nitroglycerin infusion. No other significant CAD was noted. PMID:23930243

  2. [Intermittent bundle branch block: a clinical model for the study of electrophysiological phenomena].

    Science.gov (United States)

    Costantini, Marcello

    2014-01-01

    Disorders of intraventricular conduction (bundle branch block and hemiblock) are usually stable and remain unchanged irrespective of heart rate. Not infrequently, however, their appearance is related to the duration of the cardiac cycle, so that they appear and disappear with changes in heart rate. This may not even represent a pathological phenomenon, since sudden and consistent changes in cardiac cycle can result, even physiologically, in aberrant conduction. However, when a bundle branch block appears intermittently for simple and progressive increments, or even deceleration, of the sinus rate, this is related to a true bundle branch pathology, i.e. tachycardia-dependent (or phase 3) block or bradycardia-dependent (or phase 4) block, respectively. Phase 3 block is believed to express a pathological increase in the duration of the recovery period of the bundle branch. Phase 4 block was best explained on the basis of enhanced phase 4 depolarization of the bundle branch system, with inability of excitation if the cardiac cycle is particularly prolonged. The two types of block, phase 3 and phase 4, often coexist. An intraventricular conduction disturbance that appears during increasing heart rate for a phase 3 block is maintained, if frequency slows down, even for cycles greater than those that brought about its appearance. This is due to retrograde activation of the bundle branch blocked in the antegrade direction, with delay of its action potential inscription. Sometimes, in the presence of phase 3 bundle branch block, very early atrial ectopic beats are paradoxically conducted in the normal way (supernormal conduction). Perhaps, this phenomenon is related to a possible "climb over" of the injured zone of the bundle branch by the blocked impulses that arise beyond the injured area as subliminal impulses, exciting the healthy tissues if catches them during their phase of supernormal excitability. In the presence of intermittent bundle branch block, it is not

  3. Right bundle branch block with revelation of changing axis deviation at the end of atrial fibrillation.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

    2009-11-12

    Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a left bundle branch block with changing QRS morphology and changing axis deviation. There are several possible explanations for the intermittent shift in the QRS axis in the presence of complete left bundle branch block. The most plausible explanation is the coexistence of left posterior hemiblock and predivisional left bundle branch block. Intermittent right axis deviation has been rarely reported in the presence of left bundle branch block also during atrial fibrillation and with acute myocardial infarction too. Isolated left posterior hemiblock is a very rare finding and transient right axis deviation associated with a left posterior hemiblock pattern has been also rarely described associated with acute myocardial infarction. Changing axis deviation with changing bundle branch block and new-onset of atrial fibrillation during acute myocardial infarction has been also reported. Changing axis deviation with intermittent right bundle branch block in a patient admitted with acute myocardial infarction has been also described. We present a case of a right bundle branch block with revelation of changing axis deviation at the end of atrial fibrillation in a 68-year-old Italian man.

  4. Atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca; Chiribiri, Amedeo

    2008-09-16

    Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ecg shows an LBBB with changing QRS morphology and changing axis deviation. We describe a case of atrial fibrillation with intermittent right axis deviation in the presence of complete left bundle branch block in an 84-year-old Italian woman in the Cardiology Unit.

  5. Changing axis deviation and intermittent right bundle branch block during acute myocardial infarction.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

    2011-03-03

    Dissimilar electrocardiographic patterns associated with right bundle branch block have been described. The prognosis of right bundle branch block in the absence of underlying cardiac disease is good but it may be poor in other cases, particularly coronary artery disease. Changing bundle branch block, new right bundle branch block, right bundle branch conduction disturbances have been reported in literature. Changing axis deviation has been reported alone or during acute myocardial infarction also associated with atrial fibrillation. Intermittent right axis deviation has been rarely reported in the presence of left bundle branch block also during atrial fibrillation and with acute myocardial infarction too. Isolated left posterior hemiblock is a very rare finding and transient right axis deviation associated with a left posterior hemiblock pattern has been also rarely described associated with acute myocardial infarction. We describe a case of changing axis deviation with intermittent right bundle branch block in a patient admitted with acute myocardial infarction. Also this case focuses attention on changing axis deviation and intermittent right bundle branch block during acute myocardial infarction. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  6. Brugada syndrome behind complete right bundle-branch block.

    Science.gov (United States)

    Aizawa, Yoshiyasu; Takatsuki, Seiji; Sano, Motoaki; Kimura, Takehiro; Nishiyama, Nobuhiro; Fukumoto, Kotaro; Tanimoto, Yoko; Tanimoto, Kojiro; Murata, Mitsushige; Komatsu, Takashi; Mitamura, Hideo; Ogawa, Satoshi; Funazaki, Toshikazu; Sato, Masahito; Aizawa, Yoshifusa; Fukuda, Keiichi

    2013-09-03

    The characteristic ECG of Brugada syndrome (BS) can be masked by complete right bundle-branch block (CRBBB) and exposed by resolution of the block or pharmacological or pacing maneuvers. The study consisted of 11 patients who had BS and CRBBB. BS was diagnosed before the development of CRBBB, on the resolution of CRBBB, or from new characteristic ST-segment changes that could be attributable to BS. Structural heart diseases were excluded, and coronary spasm was excluded on the basis of a provocation test at catheterization. In 7 patients, BS was diagnosed before the development of CRBBB. BS was diagnosed when CRBBB resolved spontaneously (n=1) or by right ventricular pacing (n=3). The precipitating cause for the spontaneous resolution of CRBBB, however, was not apparent. On repeated ECGs, new additional upward-convex ST-segment elevation was found in V2 or V3 in 3 patients. In 2 patients, new ST-segment elevation was induced by class IC drugs. The QRS duration was more prolonged in patients with BS and CRBBB compared with age- and sex-matched controls: 170±13 versus 145±15 milliseconds in V1 and 144±19 versus 128±7 milliseconds in V5 (both Pmask BS. BS might be demonstrated by relief of CRBBB or by spontaneous or drug-induced ST-segment elevation. The prevalence, mechanism, and clinical significance of a combination of CRBBB and BS are yet to be determined.

  7. Masquerading bundle branch block as a presenting manifestation of complete atrioventricular block that caused syncope.

    Science.gov (United States)

    Jiao, Zhenyu; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

    2017-10-01

    A 59-year-old male patient was admitted with the main complaints of stuffiness and shortness of breath. An ECG from precordial leads on admission showed masquerading bundle branch block. Syncope frequently occurred after admission. During syncope episodes, ECG telemetry showed that the syncope was caused by intermittent complete atrioventricular block, with the longest RR interval lasting for 4.36 s. At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker. Follow-up of 9 months showed no reoccurrence of syncope.

  8. Electrical remodelling in patients with iatrogenic left bundle branch block.

    Science.gov (United States)

    Engels, Elien B; Poels, Thomas T; Houthuizen, Patrick; de Jaegere, Peter P T; Maessen, Jos G; Vernooy, Kevin; Prinzen, Frits W

    2016-12-01

    Left bundle branch block (LBBB) is induced in approximately one-third of all transcatheter aortic valve implantation (TAVI) procedures. We investigated electrophysiological remodelling in patients with TAVI-induced LBBB. This retrospective study comprises 107 patients with initially narrow QRS complex of whom 40 did not and 67 did develop persistent LBBB after TAVI. 12-lead electrocardiograms (ECGs) taken before TAVI, within 24 hours ('acute'), and 1-12 months after TAVI ('chronic') were used to reconstruct vectorcardiograms. From these vectorcardiograms, QRS and T-wave area were calculated as comprehensive indices of depolarization and repolarization abnormalities, respectively. TAVI-induced LBBB resulted in significant acute depolarization and repolarization changes while further repolarization changes were observed with longer lasting LBBB. The amount of long-term repolarization changes (remodelling) was highly variable between patients. The change in T-wave area between acute and chronic LBBB ranged from +57% to - 77%. After dividing the LBBB cohort into tertiles based on the change in T-wave area, only baseline QRS area was larger in the tertile with no significant change in T-wave area. During longer lasting LBBB, the spatial vector gradient (SVG) changed orientation towards the direction of the QRS-vector, indicating that later-activated regions developed shorter action potential duration. This study in patients with TAVI-induced LBBB shows that repolarization changes develop within months after onset of LBBB, and that these changes are highly variable between individual patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.

  9. Right bundle branch block and anterior wall ST elevation myocardial infarction.

    Science.gov (United States)

    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  10. Acute myocardial infarction and left bundle branch block with changing axis deviation.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Dattilo, Giuseppe; Sturiale, Mauro

    2012-02-09

    Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a LBBB with changing QRS morphology and changing axis deviation. There are several possible explanations for the intermittent shift in the QRS axis in the presence of complete left bundle branch block. The most plausible explanation is the coexistence of left posterior hemiblock and predivisional left bundle branch block. We present a case of a left bundle branch block with changing axis deviation in a 93-year-old Italian woman admitted to the Cardiology Unit with an acute myocardial infarction. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  11. Left bundle branch block and changing axis deviation during acute myocardial infarction.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Sturiale, Mauro

    2012-03-22

    Changing axis deviation has been reported also during atrial fibrillation or atrial flutter. Changing axis deviation has been also reported during acute myocardial infarction associated with atrial fibrillation too or at the end of atrial fibrillation during acute myocardial infarction. Left bundle branch block is usually associated with normal or left axis deviation. Rarely the ECG shows a left bundle branch block with changing QRS morphology and changing axis deviation. We present a case of a left bundle branch block with changing axis deviation in an 86-year-old Italian man admitted to the Cardiology Unit with an acute myocardial infarction. Also this case focuses attention on left bundle branch block with changing axis deviation. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  12. Cardiac memory during rather than after termination of left bundle branch block.

    Science.gov (United States)

    Littmann, Laszlo; Proctor, Patrick A; Givens, Priscilla M

    2014-01-01

    An 83-year-old woman with chronic left bundle branch block and remote history of pacemaker implantation for intermittent AV block was hospitalized for fatigue and leg swelling. She had no cardiac complaints. Routine 12-lead electrocardiogram showed sinus rhythm with left bundle branch block. There were diffuse negative T waves in the inferior and anterolateral leads that were concordant with the QRS complexes. Echocardiogram was normal and nuclear perfusion heart scan showed no abnormality. It was noted that the negative T waves during left bundle branch block were in the exact same leads as were the deep negative QRS complexes during ventricular pacing. The electrocardiographic changes were consistent with cardiac memory. This case is unique because cardiac memory in patients with intermittent left bundle branch block typically occurs when the QRS complexes normalize and not during left bundle branch block itself. Our findings indicate that memory Ts can develop not only after normalization of wide complex rhythms but also with alternating wide complex rhythms as in the presented case where a ventricular paced rhythm was replaced by left bundle branch block. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Rate-Dependent Left Bundle-Branch Block in a Child With Propionic Aciduria

    Science.gov (United States)

    Ardoin, Kipp B.; Moodie, Douglas S.; Snyder, Christopher S.

    2009-01-01

    In most cases, a left bundle-branch block pattern on an electrocardiogram is a postoperative phenomenon. Under rare circumstances, it can be found in patients after myocardial infarction or in patients with hypertrophic cardiomyopathy, or it can be exercised induced. We describe a pediatric patient with propionic aciduria, dilated cardiomyopathy, and rate-dependent left bundle-branch block on her electrocardiogram. PMID:21603417

  14. Right bundle branch block pattern in right ventricular endocardial pacing: A needless concern?

    Directory of Open Access Journals (Sweden)

    Mangalachulli Pottammal Ranjith

    2013-01-01

    Full Text Available Right ventricular (RV endocardial pacing in permanent pacemaker implantation usually yields a left bundle branch block (LBBB pattern in surface electrocardiogram (ECG. The presence of right bundle branch block (RBBB pattern raises the suspicion of lead perforation. We report a case of RV endocardial permanent pacemaker implantation showing a RBBB pattern in ECG, suggesting a complication. However, further work-up revealed that the lead was appropriately located at the RV apex.

  15. Right bundle branch block as a marker for interatrial septal abnormalities.

    Science.gov (United States)

    Bakalli, Aurora; Koçinaj, Dardan; Georgievska-Ismail, Ljubica; Bekteshi, Tefik; Pllana, Ejup; Sejdiu, Basri

    2012-02-01

    Interatrial septal anomalies, which include atrial septal defect, patent foramen ovale, and atrial septal aneurysm, are common disorders among adult patients. Early detection of interatrial septal anomalies is important in order to prevent haemodynamic consequences and/or thromboembolic events. Electrocardiogram offers some clues that should serve as hints for detection of interatrial abnormalities. The aim of our study was to analyse the interatrial septum by transoesophageal echocardiography in patients with electrocardiogram signs of right bundle branch block and in those without right bundle branch block. In a prospective study, 87 adult patients were included, that is, 41 with electrocardiogram signs of right bundle branch block forming the first group and 46 without right bundle branch block forming the second group. Interatrial septal anomalies were present in 80.5% of the patients with right bundle branch block, with patent foramen ovale (39.02%) being the most prevalent disorder, followed by atrial septal aneurysm (21.9%) and atrial septal defect (19.5%). Interatrial septal abnormalities were significantly more frequent in the first group compared with the second group (80.5% versus 6.5%, p value less than 0.001). Independently, patent foramen ovale was significantly more prevalent in patients with right bundle branch block (39.02% versus 4.3%, p value less than 0.001), as were atrial septal aneurysm (21.9% versus 2.2%, p value equal 0.01) and atrial septal defect (19.5% versus 0%, p value equal 0.004). Right bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.

  16. Special features of right bundle branch block in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.

    Science.gov (United States)

    Peters, Stefan; Trümmel, Martina; Koehler, Brigitte

    2012-05-17

    We searched for special features in patients with complete and incomplete right bundle branch block diagnosed as having arrhythmogenic right ventricular cardiomyopathy/dysplasia. Whether right bundle branch block is a frequent finding in arrhythmogenic right ventricular cardiomyopathy should be studied. The question is whether special features exist such as T-wave inversions, localized right precordial QRS prolongation and r'/s ratiobundle branch block is characterized by r'/s ratiobundle branch block is characterized by ST segment elevation in right precordial leads but not by T wave inversions ≥ V4. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  17. High-degree atrioventricular block in patients with preexisting bundle branch block or bundle branch block occurring during transcatheter aortic valve implantation.

    Science.gov (United States)

    Egger, Florian; Nürnberg, Michael; Rohla, Miklos; Weiss, Thomas W; Unger, Gerhard; Smetana, Peter; Geppert, Alexander; Gruber, Susanne C; Bambazek, Anton; Falkensammer, Jürgen; Waldenberger, Ferdinand R; Huber, Kurt; Freynhofer, Matthias K

    2014-12-01

    Transcatheter aortic valve implantation (TAVI) has become the standard therapy for high-risk and non-operable patients with severe aortic stenosis. However, the procedure involves several adverse effects, such as rhythm and conduction disturbances. Patients with postprocedural left bundle branch block may have an increased mortality risk, whereas patients with preprocedural right bundle branch block display a higher rate of postinterventional bradyarrhythmias. The purpose of this study was to investigate the occurrence of high-degree atrioventricular block (AVB) in patients with preexisting bundle branch block (BBB) or BBB occurring during TAVI. In this prospective single-center study, 50 consecutive patients undergoing TAVI with the Medtronic CoreValve Revalving System were included. Of these patients, 17 with preexisting BBB or BBB occurring during TAVI received a primary prophylactic permanent DDD pacemaker, programmed to the SafeR-mode and featuring dual-channel event counters as well as stored intracardiac electrograms. Pacemaker readouts and intracardiac electrograms were analyzed for the occurrence of high-degree AVB. Ten of 17 patients (58.8%) with preexisting BBB or BBB occurring during TAVI developed episodes of high-degree AVB that were immediately terminated due to switch into DDD backup pacing. In 5 of the cases (29.4%), the first documented episode of high-degree AVB occurred after hospital discharge. Mean follow-up period was 578.1 ± 294.9 days. Development of high-degree AVB is a common complication in patients with preexisting BBB or BBB occurring during TAVI. Accordingly, intensified monitoring might be reasonable, especially in patients treated with the self-expandable Medtronic CoreValve Revalving System. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Changing axis deviation with changing bundle branch block and new-onset of atrial fibrillation during acute myocardial infarction.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca

    2009-03-06

    Paroxysmal atrial fibrillation is considered a frequent complication of acute myocardial infarction.It has been rarely reported alternating right and left bundle branch block associated with atrial fibrillation. It has also been rarely reported changing axis deviation with left bundle branch block also during atrial fibrillation and acute myocardial infarction. We present a case of changing axis deviation with changing bundle branch block and new-onset of atrial fibrillation in a 96-year-old Italian man with acute myocardial infarction.

  19. Absent right bundle branch block: Is it a clue of pre-excitation in Ebstein's anomaly?

    Science.gov (United States)

    Gangurde, Pranil Bhalchandra; Tidake, Abhay; Shah, Hetan; Mahajan, Ajay; Lokhandwala, Yash; Nathani, Pratap

    2016-09-01

    A 14-year-old male with a history of symptomatic tachycardia was referred for ablation. Sinus rhythm electrocardiogram was not showing any pre-excitation. Tachycardia episode was showing antidromic tachycardia with left bundle branch block morphology. Echocardiographic examination was showing Ebstein's anomaly with septal tricuspid leaflet displaced 24mm apically. The right bundle branch block (RBBB) was concealed during sinus rhythm. The RBBB was revealed with ablation of right posterior atriofascicular accessory pathway. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  20. Transient right bundle branch block in a patient with acute pulmonary embolism.

    Science.gov (United States)

    Gonzva, Jonathan; Viard, François-Valéry; Jost, Daniel; Lefort, Hugues; Tourtier, Jean-Pierre

    We report the case of an 86-year-old man found at home with acute chest pain and dyspnea. He presented some episodes of left chest pain combined with dyspnea. The physical examination revealed crackling sounds on the bases of the lungs without other anomalies. Electrocardiograms revealed a transient and complete right bundle branch block with inverted T waves in leads V1, V2, and V3. He was diagnosed with a proximal bilateral acute pulmonary embolism without acute cor pulmonale. We describe a case of a transient bundle branch block, without tachycardia or acute cor pulmonale, revealing a pulmonary embolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Spontaneous resolution of left bundle branch block and biventricular stimulation lead to reverse remodeling in dyssynchronopathy

    NARCIS (Netherlands)

    Kloosterman, Marielle; Rienstra, Michiel; Van Gelder, Isabelle C.; Maass, Alexander H.

    2016-01-01

    Left bundle branch block (LBBB) is considered a marker of underlying structural cardiac disease. To determine whether LBBB is cause or consequence of deterioration of left ventricular (LV) function is difficult as both are often diagnosed concomitantly. We discuss a patient where reversal of LBBB

  2. Incomplete right bundle branch block: a novel electrocardiographic marker for lone atrial fibrillation

    DEFF Research Database (Denmark)

    Nielsen, Jonas Bille; Olesen, Morten Salling; Tangø, Mogens

    2011-01-01

    Aims P-wave morphology and PR interval have both been previously associated with atrial fibrillation (AF). We hypothesized that incomplete right bundle branch block (IRBBB) would be associated with early-onset lone AF. Methods and results We conducted a case-control study comparing...

  3. Left bundle branch block as a risk factor for progression to heart failure

    DEFF Research Database (Denmark)

    Zannad, Faiez; Huvelle, Etienne; Dickstein, Kenneth

    2006-01-01

    The prevalence of conduction disturbances, particularly left bundle branch block (LBBB), is strongly correlated with age and with the presence of cardiovascular disease. LBBB has been reported to affect approximately 25% of the heart failure (HF) population and it is likely that the deleterious...

  4. Haemodynamic Benefit of Cardiac Resynchronisation Therapy Requires Left Bundle Branch Block: A Case Report

    NARCIS (Netherlands)

    Bogaard, M.D.; Leenders, G.E.H.; Doevendans, P.A.F.M.; Meine, M.

    A 55-year-old woman with dilated cardiomyopathy and rate-dependent left bundle branch block had a cardiac resynchronisation therapy (CRT) device implanted. During implantation, the maximum rate of left ventricular pressure rise (dP/dtmax) was measured invasively. This case presents

  5. Right and left bundle branch block as predictors of long-term mortality following myocardial infarction

    DEFF Research Database (Denmark)

    Lewinter, Christian; Torp-Pedersen, Christian; Cleland, John G F

    2011-01-01

    Patients with acute myocardial infarction (MI) with bundle branch block (BBB) have a poor prognosis, but distinction between left (L)- and right (R)-sided BBB is seldom made in epidemiological studies. We studied long-term mortality associated with RBBB and LBBB in the TRAndolapril Cardiac...

  6. New strict left bundle branch block criteria reflect left ventricular activation differences

    DEFF Research Database (Denmark)

    Emerek, Kasper Janus Grønn; Risum, Niels; Hjortshøj, Søren Pihlkjær

    2015-01-01

    AIMS: Pacing lead electrical delays and strict left bundle branch block (LBBB) criteria were assessed against cardiac resynchronization therapy (CRT) outcome. METHODS: Forty-nine patients with LBBB and QRS duration >130 milliseconds underwent CRT-implantation. Sensed right ventricular to left...

  7. Electrocardiographic imaging-based recognition of possible induced bundle branch blocks during transcatheter aortic valve implantations

    NARCIS (Netherlands)

    Dam, P.M. van; Proniewska, K.; Maugenest, A.M.; Mieghem, N.M. van; Maan, A.C.; Jaegere, P.P. de; Bruining, N.

    2014-01-01

    AIMS: Conventional electrocardiogram (ECG)-based diagnosis of left bundle branch block (LBBB) in patients with left ventricular hypertrophy (LVH) is ambiguous. Left ventricular hypertrophy is often seen in patients with severe aortic stenosis in which a transcatheter aortic valve implantation (TAVI)

  8. Prevalence and Prognostic Implications of Bundle Branch Block in Comatose Survivors of Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Grand, Johannes; Thomsen, Jakob Hartvig; Kjærgaard, Jesper

    2016-01-01

    This study reports the prevalence and prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in the admission electrocardiogram (ECG) of comatose survivors of out-of-hospital cardiac arrest (OHCA). The present study is part of the predefined electrocardiographic...

  9. [Results of randomized studies on cardiac resynchronization therapy and the reevaluation of cardiac ventricular activation in left bundle branch block].

    Science.gov (United States)

    Préda, István

    2013-05-05

    If New York Heart Association Class II-IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic findings in left bundle branch block provided evidence that "true" left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In "true" left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V1, V2, V5 and V6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened "left bundle branch block like" QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infiltrative disease.

  10. Electrocardiographic markers of left ventricular systolic dysfunction in patients with left bundle branch block.

    Science.gov (United States)

    Deniz, Ali; Özmen, Çağlar; Aktaş, Halil; Berk, İlayda Gül; Deveci, Onur Sinan; Çağlıyan, Çağlar Emre; Eker Akıllı, Rabia; Kanadaşı, Mehmet; Demir, Mesut; Usal, Ayhan

    2016-01-01

    Although some patients with left bundle branch block (LBBB) have structural heart diseases, some patients with LBBB have "normal hearts". The electrocardiography (ECG) criteria of LBBB in reduced left ventricular ejection fraction (LVEF) have not been defined completely. The main purpose of this study was to differentiate patients with reduced LVEF from patients with normal left ventricular systolic function simply by analysing 12-lead ECG. Subjects admitted to our hospital with LBBB in their ECG were included in the study. The patients were categorised according to their left ventricular systolic function as group 1 (LVEF ≥ 50%) and group 2 (LVEF bundle branch, and concordance/discordance of T waves in leads V5, V6, or D1 were recorded. The ECG findings of the two groups were compared. One hundred consecutive patients with LBBB were included in the study (male/female: 56/44, age: 66 ± 15 years). In the whole group, there were 35 patients with normal left ventricular systolic function (LVEF ≥ 50%), and 65 patients had LVEF below 50%. 80% of male patients with LBBB and 45% of female patients with LBBB had their LVEF below 50% (p bundle branch was more frequent in group 2 (29% in group 1 vs. 52% in group 2, p = 0.03). Male gender, QRS duration greater than 140 ms, discordant LBBB, and residual conduction in the left bundle branch seem to be markers of reduced LVEF in patients with LBBB.

  11. Differential diagnosis of tachycardia with a typical left bundle branch block morphology

    Science.gov (United States)

    Neiger, Jeffrey S; Trohman, Richard G

    2011-01-01

    The evaluation of wide QRS complex tachycardias (WCT) remains a common dilemma for clinicians. Numerous algorithms exist to aid in arriving at the correct diagnosis. Unfortunately, these algorithms are difficult to remember, and overreliance on them may prevent cardiologists from understanding the mechanisms underlying these arrhythmias. One distinct subcategory of WCTs are those that present with a “typical” or “classic” left bundle branch block pattern. These tachycardias may be supraventricular or ventricular in origin and arise from functional or fixed aberrancy, bystander or participating atriofascicular pre-excitation, and bundle branch reentry. This review will describe these arrhythmias, illustrate their mechanisms, and discuss their clinical features and treatment strategies. PMID:21666813

  12. Particularities of Coronary Artery Disease in Hypertensive Patients with Left Bundle Branch Block

    Science.gov (United States)

    ANGHEL, Larisa; ARSENESCU GEORGESCU, Catalina

    2014-01-01

    Objective: We mean to investigate whether the presence of hypertension could be associated with a more severe atherosclerotic coronary artery disease in patients with left bundle branch block. Material and methods: To assess the current incidence and meaning of hypertension associated with atherosclerotic coronary artery disease we performed a cross-sectional analysis that included 402 patients with left bundle branch block, admitted between January 2011 and June 2013 in the Cardiovascular Diseases Institute Iasi, Romania. Of these, 194 were hypertensive, especially grade 1 and 2; 272 patients had new or presumably new left bundle branch block on their presenting electrocardiograms. The median follow up was 7 days (hospitalization period). Results: The results of our study show that hypertensive patients were more likely to have a prior history of cardiovascular events, including myocardial infarction, angina pectoris, diabetes and obesity, with statistically significant differences. On the other hand, the normotensive patients had higher rates of current and previous smoking and congestive heart failure. Conventional coronary angiography was performed in 130 (67.01%) hypertensive patients and demonstrated that almost half (41.76%) of them have coronary artery disease, one in five patients being diagnosed with acute coronary syndromes. The majority of hypertensive patients evaluated by coronary angiography had either one or two coronary lesions (28.86%); in contrast, from 110 normotensive patients evaluated by coronary angiography, 78.36% had no vessel disease (p = 0.001). When coronary artery disease was present it was frequently localized on the left descendent artery in both groups, but with statistically significant differences (16.82% in normotensives vs. 32.47% in hypertensives, p = 0.001). With regards to systolic left ventricular function, normotensive patients were more likely to have a decreased ejection fraction (EF) bundle branch block and a clinical

  13. Comparison of left ventricular torsion and strain with biventricular pacing in patients with underlying right bundle branch block versus those with left bundle branch block.

    Science.gov (United States)

    De, Sabe; Popović, Zoran B; Verhaert, David; Dresing, Thomas; Wilkoff, Bruce; Starling, Randall; Tang, W H Wilson; Thomas, James D; Grimm, Richard A

    2015-04-01

    The benefits of biventricular pacing in patients with cardiac resynchronization therapy (CRT) remain poorly understood in those with right bundle branch block (RBBB). The aim of this study was to examine the differences in several speckle tracking-derived parameters, including left ventricular torsion and longitudinal strain with CRT on and off for patients with underlying left bundle branch block (LBBB) and RBBB. Twelve patients with CRT and RBBB were compared with a similar group of patients with underlying LBBB who were sent for evaluation and atrioventricular optimization. Echocardiographic images were acquired with biventricular pacing on and off. The 2 groups had similar baseline characteristics, including age, the ejection fraction, and QRS duration. During intrinsic conduction (CRT off), patients with LBBB had lower torsion angles than those with RBBB (2.3 ± 1.0° in those with LBBB vs 6.3 ± 1.0° in those with RBBB, p = 0.03) but trended toward improvements in torsional parameters, including torsional angle and peak untwisting velocity with CRT on, whereas these parameters worsened in patients with RBBB. Compared with CRT off, analyses of septal and lateral strain curves showed significant improvements in septal strain during 100% and 200% of systole with CRT on in patients with LBBB, whereas biventricular pacing resulted in a trend toward worsening of septal strain in patients with RBBB. Negligible changes were noted in lateral strain values. In conclusion, CRT favorably improves regional mechanics in patients with LBBB primarily involving the ventricular septum, with a negligible positive impact on cardiac function in patients with underlying RBBB. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Effects of an Isolated Complete Right Bundle Branch Block on Mechanical Ventricular Function.

    Science.gov (United States)

    Zhang, Qin; Xue, Minghua; Li, Zhan; Wang, Haiyan; Zhu, Lei; Liu, Xinling; Meng, Haiyan; Hou, Yinglong

    2015-12-01

    The purpose of this study was to investigate the effects of an isolated complete right bundle branch block on mechanical ventricular function. Two groups of participants were enrolled in this study: a block group, consisting of 98 patients with isolated complete right bundle branch blocks without structural heart disease, and a control group, consisting of 92 healthy adults. The diameter, end-diastolic area, end-systolic area, and right ventricular (RV) fractional area change were obtained to evaluate morphologic and systolic function by 2-dimensional sonographic technology. Systolic and diastolic velocities and time interval parameters were measured to assess mechanical ventricular performance using pulsed wave tissue Doppler imaging. Although there was no significant difference in the RV fractional area change between the patients with blocks and controls, the diameter, end-diastolic area, and end-systolic area of the RV were significantly larger in the patients with blocks (P blocks, the peak velocities during systole and early diastole and the ratio of the peak velocities during early and late diastole decreased. The block group had a prolonged pre-ejection period, electromechanical delay time, and isovolumic relaxation time, a decreased ejection time, and an increased pre-ejection period/ejection time ratio, and the myocardial performance index (Tei index) at the basal RV lateral wall was significantly increased. There were no significant differences in any echocardiographic parameters at different sites of the left ventricle. In patients with isolated complete right bundle branch blocks, systolic and diastolic functions are impaired in the RV, and follow-up is needed. © 2015 by the American Institute of Ultrasound in Medicine.

  15. Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography.

    Science.gov (United States)

    Supariwala, Azhar A; Po, Jose Ricardo F; Mohareb, Sameh; Aslam, Farhan; Kaddaha, Firas; Mian, Zainab I; Chaudhry, Farhan; Otokiti, Ahmed; Chaudhry, Farooq A

    2015-03-01

    The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All-cause mortality data were obtained from the Social Security Death Index. There were 222 (3%) patients with right bundle branch block (RBBB) and 50 (0.7%) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95% CI: 1.4-4.2; P = 0.002). A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes. © 2014, Wiley Periodicals, Inc.

  16. Is It Complete Left Bundle Branch Block? Just Ablate the Right Bundle.

    Science.gov (United States)

    Ali, Hussam; Lupo, Pierpaolo; Foresti, Sara; De Ambroggi, Guido; Epicoco, Gianluca; Fundaliotis, Angelica; Cappato, Riccardo

    2017-03-01

    Complete left bundle branch block (LBBB) is established according to standard electrocardiographic criteria. However, functional LBBB may be rate-dependent or can perpetuate during tachycardia due to repetitive concealed retrograde penetration of impulses through the contralateral bundle "linking phenomenon." In this brief article, we present two patients with basal complete LBBB in whom ablating the right bundle unmasked the actual antegrade conduction capabilities of the left bundle. These cases highlight intriguing overlap between electrophysiological concepts of complete block, linking, extremely slow, and concealed conduction. © 2016 Wiley Periodicals, Inc.

  17. [Intermittent left bundle branch block - reversal to normal conduction during general anesthesia].

    Science.gov (United States)

    Silva, Ana Maria Oliveira Correia da; Silva, Emília Alexandra Gaspar Lima da

    Transient changes in intraoperative cardiac conduction are uncommon. Rare cases of the development or remission of complete left bundle branch block under general and locoregional anesthesia associated with myocardial ischemia, hypertension, tachycardia, and drugs have been reported. Complete left bundle branch block is an important clinical manifestation in some chronic hypertensive patients, which may also be a sign of coronary artery disease, aortic valve disease, or underlying cardiomyopathy. Although usually permanent, it can occur intermittently depending on heart rate (when heart rate exceeds a certain critical value). This is a case of complete left bundle branch block recorded in the preoperative period of urgent surgery that reverted to normal intraoperative conduction under general anesthesia after a decrease in heart rate. It resurfaced, intermittently and in a heart-rate-dependent manner, in the early postoperative period, eventually reverting to normal conduction in a sustained manner during semi-intensive unit monitoring. The test to identify markers of cardiac muscle necrosis was negative. Pain due to the emergency surgical condition and in the early postoperative period may have been the cause of the increase in heart rate up to the critical value, causing blockage. Although the development or remission of this blockade under anesthesia is uncommon, the anesthesiologist should be alert to the possibility of its occurrence. It may be benign; however, the correct diagnosis is very important. The electrocardiographic manifestations may mask or be confused with myocardial ischemia, factors that are especially important in a patient under general anesthesia unable to report the characteristic symptoms of ischemia. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. Intermittent left bundle branch block - reversal to normal conduction during general anesthesia

    Directory of Open Access Journals (Sweden)

    Ana Maria Oliveira Correia da Silva

    Full Text Available Abstract Background and objectives: Transient changes in intraoperative cardiac conduction are uncommon. Rare cases of the development or remission of complete left bundle branch block under general and locoregional anesthesia associated with myocardial ischemia, hypertension, tachycardia, and drugs have been reported. Complete left bundle branch block is an important clinical manifestation in some chronic hypertensive patients, which may also be a sign of coronary artery disease, aortic valve disease, or underlying cardiomyopathy. Although usually permanent, it can occur intermittently depending on heart rate (when heart rate exceeds a certain critical value. Case report: This is a case of complete left bundle branch block recorded in the preoperative period of urgent surgery that reverted to normal intraoperative conduction under general anesthesia after a decrease in heart rate. It resurfaced, intermittently and in a heart-rate-dependent manner, in the early postoperative period, eventually reverting to normal conduction in a sustained manner during semi-intensive unit monitoring. The test to identify markers of cardiac muscle necrosis was negative. Pain due to the emergency surgical condition and in the early postoperative period may have been the cause of the increase in heart rate up to the critical value, causing blockage. Conclusions: Although the development or remission of this blockade under anesthesia is uncommon, the anesthesiologist should be alert to the possibility of its occurrence. It may be benign; however, the correct diagnosis is very important. The electrocardiographic manifestations may mask or be confused with myocardial ischemia, factors that are especially important in a patient under general anesthesia unable to report the characteristic symptoms of ischemia.

  19. Left bundle branch block, chest pain and catheterization laboratory activation: an unavoidable cascade reaction?

    Science.gov (United States)

    Ciliberti, G; Del Pinto, M; Notaristefano, F; Zingarini, G; Ambrosio, G; Cavallini, C

    2016-01-01

    Identification of acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) remains challenging. European guidelines recommend prompt reperfusion therapy in patients with suspected ongoing myocardial ischemia and new or presumably new LBBB, whereas AHA/ACC guidelines state that LBBB should not be considered diagnostic of AMI in isolation. Sgarbossa criteria and their recent modified version with the introduction of ST/S ratio can be helpful in this setting. A clinical-instrumental algorithm to manage suspected AMI in the presence of LBBB has been recently proposed. We present five paradigmatic clinical cases. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Physiological mechanisms of QRS narrowing in bundle branch block patients undergoing permanent His bundle pacing.

    Science.gov (United States)

    Teng, Alexandra E; Massoud, Louis; Ajijola, Olujimi A

    2016-01-01

    His bundle pacing is increasingly used to avoid chronic right ventricular pacing, and electrically resynchronize ventricular activation by narrowing or normalizing the QRS interval in left and right bundle branch block. The mechanisms by which this occurs remain poorly understood. In this review, the proposed mechanisms and evidence supporting them are discussed. Also discussed are aspects of mechanisms that are not completely supported by the evidence. We also review the differences and physiological bases for direct vs. indirect His bundle capture, and the physiological mechanisms for QRS narrowing vs. normalization following His bundle pacing. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Wellens' syndrome can indicate high-grade LAD stenosis in case of left bundle branch block.

    Science.gov (United States)

    Grautoff, Steffen

    2017-03-01

    Diagnosing acute myocardial infarction (AMI) in left bundle branch block (LBBB) is challenging. Modified Sgarbossa criteria are known to help detect AMI in LBBB. This is a report about an electrocardiogram (ECG) with Wellens' signs in combination with a pre-existing LBBB. The ECG of a patient with fluctuating chest pain showed very subtle and one day later more obvious Wellens'signs. A left anterior descending artery (LAD) stenosis was diagnosed and successfully treated. Wellens' syndrome can be diagnosed in a case of LBBB and help detect a high-grade LAD stenosis even if modified Sgarbossa criteria are not met.

  2. Spontaneous resolution of left bundle branch block and biventricular stimulation lead to reverse remodeling in dyssynchronopathy.

    Science.gov (United States)

    Kloosterman, Mariëlle; Rienstra, Michiel; Van Gelder, Isabelle C; Maass, Alexander H

    2016-01-01

    Left bundle branch block (LBBB) is considered a marker of underlying structural cardiac disease. To determine whether LBBB is cause or consequence of deterioration of left ventricular (LV) function is difficult as both are often diagnosed concomitantly. We discuss a patient where reversal of LBBB and subsequent normalization of LV function was observed after 2 different therapies, first after start of heart failure medication, and years later after implantation of a cardiac resynchronization device. This indicates that LBBB per se may result in the development of non-ischemic cardiomyopathy and that LBBB resolution can lead to reverse remodeling in dyssynchronopathy. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. New onset left bundle branch block with right axis deviation in a patient with Wegener's granulomatosis.

    Science.gov (United States)

    Khurana, C; Mazzone, P; Mandell, B

    2000-04-01

    Left bundle branch block (LBBB) is usually associated with a normal axis or left axis deviation (LAD). When it is seen in association with right axis deviation (RAD) it is felt to be a marker of diffuse advanced myocardial disease. We report a case of new onset LBBB with RAD in a patient with Wegener's granulomatosis who had an otherwise functionally and structurally normal heart. To our knowledge, this is the first case report of LBBB with RAD without severe cardiomyopathy, as well as the first case report of new onset LBBB as a result of Wegener's granulomatosis.

  4. Right, but not left, bundle branch block is associated with large anteroseptal scar.

    Science.gov (United States)

    Strauss, David G; Loring, Zak; Selvester, Ronald H; Gerstenblith, Gary; Tomaselli, Gordon; Weiss, Robert G; Wagner, Galen S; Wu, Katherine C

    2013-09-10

    This study sought to test the hypothesis that right bundle branch block (RBBB) patients have larger scar size than left bundle branch block (LBBB) patients do. A proximal septal perforating branch of the left anterior descending (LAD) coronary artery most commonly perfuses the right bundle branch and left anterior fascicle, but not the left posterior fascicle. Thus, proximal LAD occlusions should cause RBBB, not LBBB. We performed electrocardiograms and magnetic resonance imaging for scar quantification in 233 patients with left ventricular (LV) ejection fraction ≤35% who were receiving primary prevention implantable cardioverter-defibrillators (ICD cohort). Scar size and location were compared among patients with RBBB, LBBB, nonspecific LV conduction delay, and QRS <120 ms. A second cohort of 20 hypertrophic cardiomyopathy patients undergoing alcohol septal ablation was studied to determine whether controlled infarction in a proximal LAD septal perforator caused RBBB or LBBB. In the ICD cohort, LV ejection fraction was similar between RBBB and LBBB patients (24.9% vs. 25.0%; p = 0.98); however, RBBB patients had significantly larger scar size (24.0% vs. 6.5%; p < 0.0001). Patients with nonspecific LV conduction delay or QRS <120 ms had intermediate scar size (12.9% and 14.4%, respectively). Those with RBBB (compared with LBBB) were more likely to have ischemic heart disease (79% vs. 29%; p < 0.0001). In the alcohol septal ablation cohort, 15 of 20 patients (75%) developed RBBB, but no patients developed LBBB. In patients with LV ejection fraction ≤35%, RBBB is associated with significantly larger scar size than LBBB is, and occlusion of a proximal LAD septal perforator causes RBBB. In contrast, LBBB is most commonly caused by nonischemic pathologies. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Right ventricular septal pacing in patients with right bundle branch block.

    Science.gov (United States)

    Giudici, Michael C; Abu-El-Haija, Basil; Schrumpf, Phillip E; Bhave, Prashant D; Al Khiami, Belal; Barold, Serge S

    2015-01-01

    Cardiac resynchronization therapy (CRT) has been shown to improve left ventricular (LV) function and exercise performance in patients with left bundle branch block. Patients with right bundle branch block (RBBB) do not have a similar positive response to standard CRT. We hypothesized that single site pacing of the right ventricular septum (RVS) near the proximal right bundle could restore more normal activation of the LV in RBBB patients. 78 consecutive patients (56 M, 22 F) with baseline RBBB underwent pacemaker or ICD implantation. Leads were placed in the right atrium and RVS. Baseline QRS duration was 120-220 ms (mean QRSd = 147 ms). At the optimal AV delay, the fused QRSd was 56-160 ms (mean QRSd = 112 ms). The mean decrease in QRSd was 34 ± 20.4 ms (p<0.001). RVS pacing in patients with RBBB resulted in a marked decrease in QRS duration and often normalized the ECG. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Diagnosis of myocardial infarction and ischemia in the setting of bundle branch block and cardiac pacing.

    Science.gov (United States)

    Herweg, B; Marcus, M B; Barold, S S

    2016-09-01

    The diagnosis of myocardial infarction (MI) in the presence of left bundle branch block (LBBB) or during ventricular pacing (VP) is challenging because of inherent changes in the sequence of ventricular depolarization and repolarization associated with both conditions. Although LBBB and right ventricular (RV) pacing may both produce abnormalities in the ECG, it is often possible to diagnose an acute MI (AMI) or an old MI based on selected morphologic changes. Primary ST-segment changes scoring 3 points or greater according to the Sgarbossa criteria are highly predictive of an AMI in patients with LBBB or RV pacing. The modified Sgarbossa criteria are useful for the diagnosis of AMI in patients with LBBB; however, these criteria have not yet been studied in the setting of RV pacing. Although changes of the QRS complex are not particularly sensitive for the diagnosis of an old MI in the setting of LBBB or RV pacing, the qR complex and Cabrera sign are highly specific for the presence of an old infarct. Diagnosing AMI in the setting of biventricular (BiV) pacing is challenging. To date there is minimal evidence suggesting that the traditional electrocardiographic criteria for diagnosis of AMI in bundle branch block may be applicable to patients with BiV pacing and positive QRS complexes on their ECG in lead V1. This report is a careful review of the electrocardiographic criteria facilitating the diagnosis of acute and remote MI in patients with LBBB and/or VP.

  7. Hybrid Bacterial Foraging and Particle Swarm Optimization for detecting Bundle Branch Block.

    Science.gov (United States)

    Kora, Padmavathi; Kalva, Sri Ramakrishna

    2015-01-01

    Abnormal cardiac beat identification is a key process in the detection of heart diseases. Our present study describes a procedure for the detection of left and right bundle branch block (LBBB and RBBB) Electrocardiogram (ECG) patterns. The electrical impulses that control the cardiac beat face difficulty in moving inside the heart. This problem is termed as bundle branch block (BBB). BBB makes it harder for the heart to pump blood effectively through the heart circulatory system. ECG feature extraction is a key process in detecting heart ailments. Our present study comes up with a hybrid method combining two heuristic optimization methods: Bacterial Forging Optimization (BFO) and Particle Swarm Optimization (PSO) for the feature selection of ECG signals. One of the major controlling forces of BFO algorithm is the chemotactic movement of a bacterium that models a test solution. The chemotaxis process of the BFO depends on random search directions which may lead to a delay in achieving the global optimum solution. The hybrid technique: Bacterial Forging-Particle Swarm Optimization (BFPSO) incorporates the concepts from BFO and PSO and it creates individuals in a new generation. This BFPSO method performs local search through the chemotactic movement of BFO and the global search over the entire search domain is accomplished by a PSO operator. The BFPSO feature values are given as the input for the Levenberg-Marquardt Neural Network classifier.

  8. Mechanical dyssynchrony is similar in different patterns of left bundle-branch block.

    Science.gov (United States)

    Barretto, Rodrigo Bellio de Mattos; Piegas, Leopoldo Soares; Assef, Jorge Eduardo; Melo Neto, José Francisco; Resende, Thiago Uchoa; Moreira, Dalmo Antonio; Lebihan, David Costa; França, Francisco Faustino; Meneghelo, Romeu Sérgio; Sousa, Amanda Guerra Moraes Rego

    2013-11-01

    Left bundle-branch block (LBBB) and the presence of systolic dysfunction are the major indications for cardiac resynchronization therapy (CRT). Mechanical ventricular dyssynchrony on echocardiography can help identify patients responsive to CRT. Left bundle-branch block can have different morphologic patterns. To compare the prevalence of mechanical dyssynchrony in different patterns of LBBB in patients with left systolic dysfunction. This study assessed 48 patients with ejection fraction (EF) left electrical axis deviation in the frontal plane and QRS duration > 150 ms. The patients' mean age was 60 ± 11 years, 24 were males, and mean EF was 29% ± 7%. Thirty-two had QRS > 150 ms, and22, an electrical axis between -30º and +90º. Interventricular dyssynchrony was identified in 73% of the patients, while intraventricular dyssynchrony, in 37%-98%. Patients with QRS > 150 ms had larger left atrium and ventricle, and lower EF (p Left electrical axis deviation associated with worse diastolic function and greater atrial diameter. Interventricular and intraventricular mechanical dyssynchrony (ten methods) was similar in the different LBBB patterns (p = ns). In the two different electrocardiographic patterns of LBBB analyzed, no difference regarding the presence of mechanical dyssynchrony was observed.

  9. Myocardial blood flow assessment with 82rubidium-PET imaging in patients with left bundle branch block.

    Science.gov (United States)

    Falcão, Andréa; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares, José; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto Kalil; Meneghetti, José C

    2015-11-01

    Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. We sought to investigate rubidium-82 (82Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress 82Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal 82Rb-positron emission tomography studies and without left bundle branch block (GII). Stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (pbundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by 82Rb-positron emission tomography imaging may be useful in identifying coronary artery disease in patients with left bundle branch block.

  10. Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block.

    Science.gov (United States)

    Adams, Jonathon C; Nelson, Matthew R; Chandrasekaran, Krishnaswamy; Jahangir, Arshad; Srivathsan, Komandoor

    2013-08-20

    Altered hemodynamics of a failing right ventricle (RV) may place stress on the right bundle branch and Purkinje network, which may be evident as conduction delay on surface electrocardiogram (ECG). We hypothesized that prolonged R' duration in lead V1 would be an indicator of RV dysfunction in patients with RBBB. The Mayo Clinic Arizona echocardiography database was reviewed from 2007 to 2009 to identify patients with RV dysfunction and coexistent right bundle branch block (RBBB). Specific ECG features of RBBB were compared between the RV dysfunction cohort and a randomly selected control population. Features found to be predictive of RV dysfunction were then tested on 100 consecutive patients with RBBB on ECG between January and June 2010. In lead V1, the QRS duration was longer in the RV dysfunction cohort (164 ± 22 ms) compared to controls (148 ± 12 ms), predominantly due to R' prolongation (117 ± 27 ms vs. 87 ± 13 ms, p<.001). Retrospective analysis suggested that V1 R' duration ≥ 100 ms may be 82.3% specific for the presence of RV systolic dysfunction. When applied prospectively, V1 R' duration ≥ 100 ms yielded sensitivity and specificity of 39.0% and 82.9% respectively for detection of abnormal RV systolic function with a positive predictive value of 76.7%. Lead V1 R' duration ≥ 100 ms is predictive of RV systolic dysfunction in patients with RBBB. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  11. Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

    Science.gov (United States)

    Arora, Sameer; Ahmad, Ali; Sood, Mike; El Sergany, Amaar; Sacchi, Terrence; Saul, Barry; Gaglani, Rahul; Heitner, John

    2016-01-01

    Background Right ventricular (RV) failure has proven to be independently associated with adverse outcomes. Electrocardiographic parameters assessing RV function are largely unknown, making echocardiography the first line for RV function assessment. It is however, limited by geometrical assumptions and is inferior to cardiac magnetic resonance imaging (CMRI) which is widely regarded as the most accurate tool for assessing RV function. Methods We seek to determine the correlation of ECG parameters of right bundle branch block (RBBB) with RV ejection fraction (EF) and RV dimensions using the CMRI. QRS duration, R amplitude and R’ duration were obtained from precordial lead V1; S duration and amplitude were obtained from lead I and AVL. RV systolic dysfunction was defined as RV EF 100 msec to detect RV systolic dysfunction was found to be 93%. R’ duration was found to have an inverse correlation with RV EF (r=−0.49, P=0.007). Conclusions Larger RV end systolic volumes seen with RV dysfunction can affect the latter part of right bundle branch leading to prolonged R’ duration. We here found prolonged R’ duration in lead V1 to have a highly specific inverse correlation to RV systolic function. ECG can be used as an inexpensive tool for RV function assessment and should be used alongside echocardiography to evaluate RV dysfunction when CMRI is not available. PMID:27747166

  12. Left bundle branch block and right axis deviation: a report of 36 cases.

    Science.gov (United States)

    Childers, R; Lupovich, S; Sochanski, M; Konarzewska, H

    2000-01-01

    Right axis deviation (RAD) with left bundle branch block (LBBB) is a rare combination. From a database of 636,000 electrocardiograms we report a series of 36 patients with this disorder. The majority of subjects had dilated cardiomyopathy with biventricular enlargement. LBBB was fixed in 21 of 36 cases. It was freshly acquired, episodic, intermittent, or physiologic in 15 of 36. The RAD was episodic in 30 of 36; it was fixed and concurrent with LBBB in only 2 cases, and never episodically concurrent. Reported for the first time here were 4 of 36 cases in which the combination of LBBB and RAD was elicited with atrial premature impulses as a rare form of QRS aberration. In one case where the combination was intermittent, a clear relationship with freshly acquired intermittent posterior fascicular block was demonstrated. The possible relationship of the deviation with variable degrees of right ventricular overload is discussed.

  13. Frequency and prognosis of new bundle branch block induced by surgical aortic valve replacement.

    Science.gov (United States)

    Poels, Thomas T; Houthuizen, Patrick; Van Garsse, Leen A F M; Soliman Hamad, Mohammed A; Maessen, Jos G; Prinzen, Frits W; Van Straten, Albert H M

    2015-02-01

    Recently, transcatheter aortic valve implantation has been introduced, but one of its complications is left bundle branch block (LBBB), a conduction disturbance that has been associated with increased mortality. We investigated the incidence and fate of both right bundle branch block (RBBB) and LBBB after aortic valve replacement (AVR) using a retrospective analysis. We also studied the predictive value of both disorders for all-cause mortality. All patients who underwent AVR, with or without concomitant coronary artery bypass grafting surgery, between 2002 and 2010 in our centre were included. All-cause mortality was compared between patients who did and those who did not develop persistent new bundle branch block (BBB) within 7 days postoperatively. Patients were not eligible if one of their electrocardiogram (ECG) recordings prior to AVR showed a BBB or pacemaker activity. A postoperative period of 3-12 months was used to collect follow-up ECGs. Of the 2279 AVR patients, 2033 patients were eligible for analysis. After excluding patients lacking baseline or follow-up ECG (n = 269), 1764 patients remained for analysis. Early LBBB and RBBB occurred in 71 (4.0%) and 92 (5.2%) patients, respectively. At follow-up, LBBB was persistent in 29 patients (1.6%) and RBBB in 74 patients (4.2%). During a median follow-up of 4.5 (2.4-6.5) years, the mortality rate was 16.3% (n = 271) in patients without BBB, 24.1% (n = 7) in patients with persistent LBBB and 18.9% (n = 14) in patients with persistent RBBB (log-rank P = 0.49). Though, in univariate analysis, the hazard ratio for mortality was 1.54 and 1.10 for LBBB and RBBB, respectively, the small numbers precluded identifying AVR-induced LBBB and RBBB as a predictor of mortality. In the current practice of AVR, persistent postoperative LBBB and RBBB occur infrequently (∼ 5% of cases), a percentage less than half of that in current transcatheter aortic valve implantation procedures. Given the adverse effects of LBBB, the

  14. Cardiac Resynchronization Therapy Relieves Intractable Angina Due to Exercise-Induced Left Bundle Branch Block Without Left Ventricular Systolic Dysfunction: A Detailed Case Study.

    Science.gov (United States)

    Czuriga, Daniel; Lim, Pitt O

    2016-05-01

    Exercise-induced left bundle branch block is rare and can be demonstrated with exercise testing. When the heart rate reaches a certain threshold, the QRS widens into left bundle branch block. This paper describes a patient with exercise-induced left bundle branch block related angina and dyspnea, who responded to cardiac resynchronization therapy. We documented the potential benefits of cardiac resynchronization therapy with a left ventricular rapid pacing study prior to its implantation. Although exercise-induced left bundle branch block is not a current indication for cardiac resynchronization therapy in patients such as ours, it could be considered when conventional drug therapy fails. © 2016 Wiley Periodicals, Inc.

  15. Diagnostic accuracy of computer-assisted electrocardiography in the diagnosis of left ventricular hypertrophy in left bundle branch block.

    Science.gov (United States)

    Rodríguez-Padial, Luis; Rodríguez-Picón, Blanca; Jerez-Valero, Miguel; Casares-Medrano, Julio; Akerström, Finn O; Calderon, Alberto; Barrios, Vivencio; Sarría-Santamera, Antonio; González-Juanatey, José R; Coca, Antonio; Andrés, Josep; Ruiz-Baena, Jessica

    2012-01-01

    Left ventricular hypertrophy has important prognostic implications. Although electrocardiography is the technique most often recommended in the diagnosis of hypertrophy, its diagnostic accuracy is hampered in the presence of a left bundle branch block. In 1875 consecutive patients (56±16 years) undergoing studies to rule out heart disease and/or hypertension, 2-dimensional echocardiography and electrocardiography were performed simultaneously in an outpatient clinic. Digitized electrocardiograms were interpreted using an online computer-assisted platform (ELECTROPRES). Sensitivity, specificity, likelihood ratios, and predictive values of standard electrocardiographic criteria and of some diagnostic algorithms for left ventricular hypertrophy were determined and compared with the findings in patients with neither left bundle branch block nor myocardial infarction. Left bundle branch block was present in 233 (12%) patients. Left ventricular hypertrophy was detected more frequently in patients with left bundle branch block (60% vs 31%). In patients with left bundle branch block, sensitivities were low but similar to those observed in patients without it, and ranged from 6.4% to 70.9%, whereas specificities were high, ranging from 57.6% to 100%. Positive likelihood ratios ranged from 1.33 to 4.94, and negative likelihood ratios from 0.50 to 0.98. Diagnostic algorithms, voltage-duration products, and certain compound criteria had the best sensitivities. Left ventricular hypertrophy can be diagnosed in the presence of left bundle branch block with an accuracy at least similar to that observed in patients without this conduction defect. Computer-assisted interpretation of the electrocardiogram may be useful in the diagnosis of left ventricular hypertrophy as it enables the implementation of more accurate algorithms. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  16. New-Onset Left Bundle Branch Block Induced by Transcutaneous Aortic Valve Implantation.

    Science.gov (United States)

    Massoullié, Grégoire; Bordachar, Pierre; Ellenbogen, Kenneth A; Souteyrand, Géraud; Jean, Frédéric; Combaret, Nicolas; Vorilhon, Charles; Clerfond, Guillaume; Farhat, Mehdi; Ritter, Philippe; Citron, Bernard; Lusson, Jean-R; Motreff, Pascal; Ploux, Sylvain; Eschalier, Romain

    2016-03-01

    New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Comparison of the calculation QRS angle for bundle branch block detection

    Science.gov (United States)

    Goeirmanto, L.; Mengko, R.; Rajab, T. L.

    2016-04-01

    QRS angle represent condition of blood circulation in the heart. Normally QRS angle is between -30 until 90 degree. Left Axis Defiation (LAD) and Right Axis Defiation (RAD) are abnormality conditions that lead to Bundle Branch Block. QRS angle is calculated using common method from physicians and compared to mathematical method using difference amplitudos and difference areas. We analyzed the standard 12 lead electrocardiogram data from MITBIH physiobank database. All methods using lead I and lead avF produce similar QRS angle and right QRS axis quadrant. QRS angle from mathematical method using difference areas is close to common method from physician. Mathematical method using difference areas can be used as a trigger for detecting heart condition.

  18. Exercise-induced left bundle branch block: an infrequent phenomenon: Report of two cases

    Science.gov (United States)

    Said, Salah AM; Bultje-Peters, Marisa; Nijhuis, Rogier LG

    2013-01-01

    Exercise-induced left bundle branch block (EI-LBBB) is infrequent phenomenon. We present two patients with angina pectoris who developed EI-LBBB during exercise tolerance test. The first patient with typical angina pectoris had significant obstructive coronary artery disease (CAD) requiring percutaneous coronary intervention of multiple lesions including placement of drug eluting stents. The second patient had atypical chest pain without signs of CAD at all. EI-LBBB occurred at a heart rate of 80 bpm and 141 bpm in the first and second patient, respectively. EI-LBBB remained visible through the test till the recovery period in the first patient at a heart rate of 83 bpm and disappeared at 96 bpm in the second patient. Both patients with this infrequent phenomenon are discussed and the literature is reviewed. PMID:24109500

  19. Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula

    Directory of Open Access Journals (Sweden)

    Stephen P. Juraschek

    2011-01-01

    Full Text Available Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described, fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain, signs of heart failure, and a new left bundle branch block (LBBB. Cardiac catheterization revealed a small left anterior descending (LAD-to-pulmonary artery (PA fistula. Diuresis led to subjective improvement of the patient's symptoms and within several days the LBBB resolved. We hypothesize that the coronary fistula in this patient contributed to transient ischemia of the LAD territory through a coronary steal mechanism. We elected to observe rather than repair the fistula, as his symptoms and ECG changes resolved with treatment of his heart failure.

  20. Adenosine Stress Induced Left Bundle Branch Block During Technetium-99m Tetrofosmin Myocardial Perfusion Imaging.

    Science.gov (United States)

    Jayanthi, Mohan Roop; Sasikumar, Arun; Gorla, Arun Kumar Reddy; Sood, Ashwani; Bhattacharya, Anish; Mittal, Bhagwant Rai

    2017-01-01

    The occurrence of left bundle branch block (LBBB) in electrocardiogram during exercise testing is a relatively rare finding. The incidence of LBBB during exercise testing ranges from 0.5% to 1.1%. The mechanism of exercise-induced LBBB (EI-LBBB) is poorly understood, but ischemia is a proposed etiology. Stress myocardial perfusion imaging (MPI) can be useful in patients with EI-LBBB to rule out coronary artery disease. Adenosine vasodilator stress is the preferred mode of stress in patients with LBBB for performing stress-MPI. Here we present an interesting case of adenosine-induced LBBB during stress-MPI in a 67-year-old female patient with normal coronary angiography.

  1. Significance of an isolated new right bundle branch block in a patient with chest pain.

    Science.gov (United States)

    Gilliot, Geraldine; Monney, Pierre; Muller, Olivier; Hugli, Olivier

    2015-06-08

    Chest pain is a common presenting symptom in emergency departments, and a typical manifestation of acute myocardial infarction (AMI). Recognition of ECG changes in AMI is essential for timely diagnosis and treatment. Right bundle branch block (RBBB) may be an isolated sign of AMI, and was previously considered as a criterion for fibrinolytic therapy. Since the most recent European Society of Cardiology and American Heart Association guidelines in 2013, RBBB alone is no longer considered a diagnostic criterion of AMI, even if it occurs in the context of acute chest pain, as RBBB does not usually interfere with the interpretation of ST-segment alteration. Our case illustrates an acute septal myocardial infarction with an isolated RBBB, and thus the importance of recognising this pattern in order to permit timely diagnosis and treatment. 2015 BMJ Publishing Group Ltd.

  2. Detection of Bundle Branch Block using Adaptive Bacterial Foraging Optimization and Neural Network

    Directory of Open Access Journals (Sweden)

    Padmavthi Kora

    2017-03-01

    Full Text Available The medical practitioners analyze the electrical activity of the human heart so as to predict various ailments by studying the data collected from the Electrocardiogram (ECG. A Bundle Branch Block (BBB is a type of heart disease which occurs when there is an obstruction along the pathway of an electrical impulse. This abnormality makes the heart beat irregular as there is an obstruction in the branches of heart, this results in pulses to travel slower than the usual. Our current study involved is to diagnose this heart problem using Adaptive Bacterial Foraging Optimization (ABFO Algorithm. The Data collected from MIT/BIH arrhythmia BBB database applied to an ABFO Algorithm for obtaining best(important feature from each ECG beat. These features later fed to Levenberg Marquardt Neural Network (LMNN based classifier. The results show the proposed classification using ABFO is better than some recent algorithms reported in the literature.

  3. The electrocardiographic characteristics of septal flash in patients with left bundle branch block.

    Science.gov (United States)

    Corteville, Ben; De Pooter, Jan; De Backer, Tine; El Haddad, Milad; Stroobandt, Roland; Timmermans, Frank

    2017-01-01

    In patients with systolic heart failure and left bundle branch block (LBBB), septal flash (SF) movement has been described by echocardiography. We evaluated the prevalence of SF in LBBB and non-LBBB patients and evaluated whether specific electrocardiographic (ECG) characteristics within LBBB are associated with the presence of SF on echocardiography. One hundred and four patients with probable LBBB on standard 12-lead ECG were selected, 40 patients with non-LBBB served as controls. Left bundle branch block and non-LBBB were defined, according to the most recent guidelines. The presence of SF was assessed by echocardiography. Strict LBBB criteria were met in 93.3% of the patients. Septal flash was present in 45.2% of LBBB patients and was not present in non-LBBB patients. This was more prevalent in patients without anterior ischaemic cardiomyopathy (ICMP) compared with those with anterior ICMP (P = 0.008). The duration of QRS was longer in SF patients compared with that of non-SF patients (P < 0.05). The presence of a mid-QRS notching in more than two consecutive leads was a good predictor for the presence of SF (P = 0.01), and when combined with an absent R-wave in lead V1, the presence of SF is very likely (P = 0.001). Our data show that SF is present in 45.2% of LBBB patients, whereas it was absent in patients with non-LBBB. Patients with SF fulfilled more LBBB criteria compared with LBBB patients without SF. Our findings raise the provocative question of whether the presence of SF identifies patients with 'true LBBB' and whether this echocardiographic finding might be considered as a selection parameter in cardiac resynchronization therapy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. Long-Term Cardiovascular Outcomes In Patients With Angina Pectoris Presenting With Bundle Branch Block

    Science.gov (United States)

    Bansilal, Sameer; Aneja, Ashish; Mathew, Verghese; Reeder, Guy S.; Smars, Peter A.; Lennon, Ryan J.; Wiste, Heather J.; Traverse, Kay; Farkouh, Michael E.

    2011-01-01

    The long-term outcomes of unselected patients with angina pectoris and a bundle branch block (BBB) on the initial electrocardiogram are not well established. The Olmsted County Chest Pain Study is a community-based cohort of 2271 consecutive patients presenting to three Olmsted County emergency departments with angina from 1985 to 1992. Patients were followed for major adverse cardiovascular events (MACE) including death, myocardial infarction, stroke and revascularization at 30 days and over a median follow-up period of 7.3 years and for mortality only through a median of 16.6 years. Cox models were used to estimate the associations between bundle branch block and cardiovascular outcomes. The mean age of the cohort on presentation was 63 years, with 58% men. MACE at 30 days occurred in 11% with RBBB, 8.8 % with LBBB and 6.4 % in patients without BBB (p=0.17). Over a median follow-up of 7.3 years, patients with BBB were at higher risk for MACE (RBBB HR 1.85, 95% CI 1.44–2.38; p<0.001 and LBBB HR 2.04, 95% CI 1.62–2.56; p<0.001) compared to those without BBB. Over a median of 16.6 years, both BBB groups had lower survival rates than patients without BBB (RBBB HR 2.19, 95% CI 1.73–2.78; p<0.001 and LBBB HR 3.32, 95% CI 2.67–4.13; p ≤ 0.001), but after adjustment for multiple risk factors, an increased risk of mortality for LBBB remained significant. In conclusion, the appearance of LBBB or RBBB in patients presenting with angina predicts adverse long-term cardiovascular outcomes compared to patients without BBB. PMID:21439535

  5. The Prognostic Significance of Right Bundle Branch Block: A Meta-analysis of Prospective Cohort Studies.

    Science.gov (United States)

    Xiong, Yunyun; Wang, Lian; Liu, Wenyan; Hankey, Graeme J; Xu, Biao; Wang, Shang

    2015-10-01

    The prognostic significance of right bundle branch block (RBBB) is inconsistent across studies. We aimed to assess the association between RBBB (in general population and patients with heart disease) and risk of all-cause mortality, cardiac death, acute myocardial infarction (MI), and heart failure (HF). RBBB may be associated with increased risk of death. PubMed, EMBASE, and the Cochrane Library up to February 2015 were searched for prospective cohort studies that reported RBBB at baseline and all-cause mortality, cardiac death, MI, and HF at follow-up. A meta-analysis of published data was undertaken primarily by means of fixed-effects models. Nineteen cohort studies including 201 437 participants were included with a mean follow-up period ranging from 1 to 246 months. For general population with RBBB, the pooled adjusted hazard ratio (HR) for all-cause mortality was 1.17 (95% confidence interval [CI]: 1.03-1.33) compared with no BBB. General population with RBBB had an increased risk of cardiac death (HR: 1.43, 95% CI: 1.17-1.74). For patients with RBBB and acute MI, the pooled risk ratio was 2.31 (95% CI: 2.13-2.49) for in-hospital mortality, 2.85 (95% CI: 2.46-3.30) for 30-day mortality, and 1.96 (95% CI: 1.59-2.42) for longer-term mortality. For acute HF patients, the pooled risk ratio of all-cause mortality was 1.11 (95% CI: 1.06-1.16), and for chronic HF patients it was 1.75 (95% CI: 1.38-2.22). Right bundle branch block is associated with an increased risk of mortality in general population and patients with heart disease. © 2015 Wiley Periodicals, Inc.

  6. Left bundle branch block and suspected myocardial infarction: does chronicity of the branch block matter?

    Science.gov (United States)

    Liakopoulos, Vasileios; Kellerth, Thomas; Christensen, Kjeld

    2013-06-01

    Our aim was to investigate if patients with suspected myocardial infarction (MI) and a new or presumed new left bundle branch block (nLBBB) were treated according to the ESC reperfusion guidelines and to compare them with patients having a previously known LBBB (oLBBB). Furthermore, we investigated the prevalence of ST-segment concordance in this population. Retrospective data was collected from the Swedeheart registry for patients admitted to the cardiac care unit at Örebro University Hospital with LBBB and suspected MI during 2009 and 2010. The patients were divided in two age groups; <80 or ≥80 years and analysed for LBBB chronicity (nLBBB or oLBBB), MI, and reperfusion treatment. We also compared our data with the national Swedeheart database for 2009. A total of 99 patients fulfilled the inclusion criteria. A diagnosis of MI was significantly more common in the group ≥80 years compared to the group <80 years (53.8 vs. 25%, p=0.007). The rate of MI was similar in the groups with nLBBB and oLBBB (33 and 37% respectively, p=0.912). Of the 36 patients with a final diagnosis of MI, only eight (22%) had nLBBB. Reperfusion treatment, defined as an acute coronary angiography with or without intervention, was significantly more often performed in patients with nLBBB compared to patients with oLBBB (42 vs. 8%, p<0.001). The rate of MI and reperfusion treatment did not differ between our institution and the Swedish national data. ST-concordance was present in only two cases, one of which did not suffer an MI. The proportion of patients receiving reperfusion treatment was low, but higher in nLBBB, reflecting a partial adherence to the guidelines. We found no correlation between LBBB chronicity and MI. Furthermore, only a minority of the MIs occurred in patients with nLBBB. ST-concordance was found in only one of 36 MI cases, indicating lack of sensitivity for this test.

  7. Transcatheter heart valve selection and permanent pacemaker implantation in patients with pre-existent right bundle branch block

    NARCIS (Netherlands)

    L. van Gils (Lennart); D. Tchetche (Didier); Lhermusier, T. (Thibault); M. Abawi (Masieh); N. Dumonteil (Nicolas); Olivares, R.R. (Ramón Rodriguez); de Nicolas, J.M. (Javier Molina-Martin); P.R. Stella (Pieter); D. Carrié (Didier); P.P.T. de Jaegere (Peter); N.M. van Mieghem (Nicolas)

    2017-01-01

    textabstractBackground-Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement

  8. Transcatheter heart valve selection and permanent pacemaker implantation in patients with pre-existent right bundle branch block

    NARCIS (Netherlands)

    van Gils, Lennart; Tchetche, Didier; Lhermusier, Thibault; Abawi, Masieh; Dumonteil, Nicolas; Rodriguez Olivares, R; de Nicolas, Javier Molina Martin; Stella, Pieter R.; Carrié, Didier; De Jaegere, Peter P.; Van Mieghem, Nicolas M.

    2017-01-01

    Background-Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM

  9. [Intraoperative transient incomplete left bundle branch block in a patient with left axis deviation in pre-anesthetic electrocardiogram].

    Science.gov (United States)

    Sunaguchi, M; Imai, H; Shigemi, K; Imai, R; Ozaki, Y; Nakamura, Y; Tanaka, Y

    1998-11-01

    We encountered a case of transient incomplete left bundle branch block (TILBBB) during standard mastectomy under general anesthesia. The patient was a 40 year-old female (70 kg, 164 cm) without any abnormalities on preanesthetic examinations except -61 degrees left axis deviation in exercise electrocardiogram. Adriamycin 20 mg was administered preoperatively. After the skin incision, heart rate increased from 104 min-1 to 130 min-1 and the cardiac axis gradually rotated leftward with increasing Q wave depth on leads I and aVL. We diagnosed this as blockade of the anterior branch in the left bundle branch. After the administration of fentanyl (0.2 mg) and sevoflurane (3%), the heart rate decreased to 105 min-1 and the electrocardiogram returned to the initial wave form. This anesthetic course indicated that adriamycin had slightly damaged the cardiac muscle and inadequate anesthesia had caused tachycardia and transient left bundle branch block. Left axis deviation on preoperative exercise electrocardiogram suggests that the left bundle branch can easily be blocked with an increasing heart rate. Adequate depth of anesthesia would have prevented the increase in heart rate and abnormality in the cardiac conduction process.

  10. Right bundle branch block: prevalence, risk factors, and outcome in the general population: results from the Copenhagen City Heart Study.

    Science.gov (United States)

    Bussink, Barbara E; Holst, Anders G; Jespersen, Lasse; Deckers, Jaap W; Jensen, Gorm B; Prescott, Eva

    2013-01-01

    To determine the prevalence, predictors of newly acquired, and the prognostic value of right bundle branch block (RBBB) and incomplete RBBB (IRBBB) on a resting 12-lead electrocardiogram in men and women from the general population. We followed 18 441 participants included in the Copenhagen City Heart Study examined in 1976-2003 free from previous myocardial infarction (MI), chronic heart failure, and left bundle branch block through registry linkage until 2009 for all-cause mortality and cardiovascular outcomes. The prevalence of RBBB/IRBBB was higher in men (1.4%/4.7% in men vs. 0.5%/2.3% in women, P bundle branch block was associated with significantly increased all-cause and cardiovascular mortality in both genders with age-adjusted hazard ratios (HR) of 1.31 [95% confidence interval (CI), 1.11-1.54] and 1.87 (95% CI, 1.48-2.36) in the gender pooled analysis with little attenuation after multiple adjustment. Right bundle branch block was associated with increased risk of MI with an HR of 1.67 (95% CI, 1.16-2.42) and pacemaker insertion with an HR of 2.17 (95% CI, 1.22-3.86), but not with chronic heart failure (HR 1.37; 95% CI, 0.96-1.94), atrial fibrillation (HR 1.10; 95% CI, 0.73-1.67), or chronic obstructive pulmonary disease (HR 0.99; 95% CI, 0.60-1.62). The presence of IRBBB was not associated with any adverse outcome. In this cohort study, RBBB and IRBBB were two to three times more common among men than women. Right bundle branch block was associated with increased cardiovascular risk and all-cause mortality, whereas IRBBB was not. Contrary to common perception, RBBB in asymptomatic individuals should alert clinicians to cardiovascular risk.

  11. Prognostic significance of acute bundle branch block in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Mijailović Vuk

    2008-01-01

    Full Text Available Background/Aim. Acute bundle branch block (ABBB presence is associated with the increasing mortality of patients with acute myocardial infarction (AMI. The aim of this study was investigate ABBB influence with respect to in-hospital (IN and long-term mortality in patients with AIM, as well as total mortality in follow-up, the presence of in-hospital congestive cardiac insufficiency (CCI and the presence of CCI at follow-up. Methods. This study included 606 consecutive patients with AMI. A total of 415 (68.5% were males and 191 (31.5% females, mean age 64.0±11.9. After the dismissal the patients underwent 18-month follow-up period. Results. Acute bundle branch block was registered in 44 patients (7.2%, out of which 15 patients (2.4% had the left (L ABBB and 29 patients (4.8% had the right (R ABBB. The patients with ABBB showed higher proportion of IH CCI (Killip III and IV and hypotension compared with the control group (patients without ABBB. In the group of patients with ABBB β-blockers, statins, aspirin and ACE-inhibitors were less applied. All the three ABBB groups exhibited an increased IH mortality (ABBB 47.7% vs 11.2%, p < 0.01, ARBBB 55.1% vs 11.2% p < 0.01, ALBBB 33.3% vs 11.2%, p < 0.01. Follow-up mortality of the patients with ABBB and ALBBB was higher in comparison with the control group (log-rank p = 0.046 and log-rank p = 0.01, respectively, whereas the group with ARBBB did not show any differences (log-rank, p = 0.59. Conclusion. The patients with ABBB AMI are a risk group of patients that commonly exhibit both early and remote CCI accompanied by high mortality. That is the reason why this sub-group of AMI patients should receive an urgent diagnostics followed by aggressive therapeutic treatment.

    This article has been retracted. Link to the retraction 10.2298/VSP0901074U

  12. Evolving considerations in the management of patients with left bundle branch block and suspected myocardial infarction

    Science.gov (United States)

    Neeland, Ian J.; Kontos, Michael C.; de Lemos, James A.

    2012-01-01

    Patients with a suspected acute coronary syndrome (ACS) and left bundle branch block (LBBB) present a unique diagnostic and therapeutic challenge to the clinician. Although current guidelines recommend that patients with new or presumed new LBBB undergo early reperfusion therapy, data suggest that only a minority of patients with LBBB are ultimately diagnosed with acute myocardial infarction regardless of LBBB chronicity and that a significant proportion of patients will not have an occluded culprit artery at cardiac catheterization. The current treatment approach exposes a significant proportion of patients to the risks of fibrinolytic therapy without the likelihood of significant benefit, and leads to increased rates of false-positive cardiac catheterization laboratory activation, unnecessary risks, and costs. Therefore, alternative strategies to those for patients with ST-elevation myocardial infarction (STEMI) are needed to guide selection of appropriate patients with suspected ACS and LBBB for urgent reperfusion therapy. In this article, we describe the evolving epidemiology of LBBB in ACS and discuss controversies related to current clinical practice. We propose a more judicious diagnostic approach among clinically stable patients with LBBB who do not have electrocardiographic findings highly specific for STEMI. PMID:22766335

  13. Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry.

    Science.gov (United States)

    Alkindi, Fahad; El-Menyar, Ayman; Al-Suwaidi, Jassim; Patel, Ashfaq; Gehani, Abdurrazzak A; Singh, Rajvir; Albinali, Hajar; Arabi, Abdulrahman

    2015-10-01

    Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB. © The Author(s) 2014.

  14. Incidence and Clinical Significance of Brugada Syndrome Masked by Complete Right Bundle-Branch Block.

    Science.gov (United States)

    Wada, Tadashi; Nagase, Satoshi; Morita, Hiroshi; Nakagawa, Koji; Nishii, Nobuhiro; Nakamura, Kazufumi; Kohno, Kunihisa; Ito, Hiroshi; Kusano, Kengo F; Ohe, Tohru

    2015-01-01

    Brugada syndrome (BrS)-type electrocardiogram (ECG) is concealed by complete right bundle-branch block (CRBBB) in some cases of BrS. Clinical significance of BrS masked by CRBBB is not well known. We reviewed an ECG database of 326 BrS patients who had type 1 ECG with or without pilsicainide. "BrS masked by CRBBB" was defined on ECG as elevation of the J point at the time of CRBBB in the right precordial leads, and BrS-type J-point elevation ≥2 mm at the time of normalized QRS complex on relieved CRBBB. We identified 25 BrS patients (7.7%) with persistent (n=12) or intermittent CRBBB (n=13). Relief of CRBBB by pacing was performed in patients with persistent CRBBB. The prevalence of BrS masked by CRBBB was 3.1% (10/326 patients). Three patients had type 1 ECG, and 7 patients had type 2 or 3 ECG on relief of CRBBB. Two of these 10 patients had lethal arrhythmic events during the follow-up period (mean, 86.4±57.2 months). There was no prognostic difference between BrS masked by CRBBB and other BrS. In a small BrS population, CRBBB can completely mask typical BrS-type ECG. BrS masked by CRBBB is associated with the same risk of fatal ventricular tachyarrhythmia as other BrS.

  15. A New Formula for Estimating the True QT Interval in Left Bundle Branch Block.

    Science.gov (United States)

    Wang, Binhao; Zhang, L I; Cong, Peixin; Chu, Huimin; Liu, Ying; Liu, Jinqiu; Surkis, William; Xia, Yunlong

    2017-06-01

    QT prolongation is an independent risk factor for cardiac mortality. Left bundle branch block (LBBB) is more common in patients as they age. Widening of the QRS in LBBB causes false QT prolongation and thus makes true QT assessment difficult. We aimed to develop a simple formula to achieve a good estimate of the QT interval in the presence of LBBB. To determine the effect of QRS duration on the QT interval, QRS and QT were measured in sinus rhythm and during right ventricular apical pacing in 62 patients (age 55 ± 11 years, 60% male) undergoing electrophysiology studies. A QT formula for LBBB (QT-LBBB) was derived based on the effect of increased QRSLBBB on QTLBBB . The predictive accuracy of the QT-LBBB formula was then tested in 22 patients (age 66 ± 13 years, 64% male) with intermittent LBBB with comparisons to prior QT formulae and JT index. On average, the net increase in QRSLBBB constituted 92% of the net increase in QTLBBB . A new formula, QT-LBBB = QTLBBB - (0.86 * QRSLBBB - 71), which takes the net increase in QRSLBBB into account, best predicted the QT interval with heart rate corrected QTc in the test set of LBBB ECGs when compared to the baseline value and prior formulae. The QT-LBBB formula developed in this study best estimates the true QT interval in the presence of LBBB. It is simple and therefore can be easily utilized in clinical practice. © 2017 Wiley Periodicals, Inc.

  16. Relationship between electrocardiographic characteristics of left bundle branch block and echocardiographic findings.

    Science.gov (United States)

    Lépori, Augusto J; Mishima, Ricardo S; Rodriguez, Gonzalo; Moreyra, Eduardo A; Serra, Jose L; Tibaldi, Miguel A; Martellotto, Andres; Moreyra, Eduardo

    2015-01-01

    Complete left bundle branch block (CLBBB) is an electrocardiographic (ECG) dromotropic disorder seen in patients with various structural heart diseases and sometimes is associated with poor prognosis. Its presence confounds the application of standard ECG criteria for the diagnosis of left ventricular hypertrophy (LVH), myocardial infarction (MI) in the chronic phase, and pathologies that produce changes on ST-T segment. The aim of this investigation was to establish the relationship between CLBBB and cardiac structural abnormalities assessed by echocardiography. This observational, cross-sectional study included ECG with CLBBB from 101 patients who also had transthoracic echocardiogram (TTE) performed within 6 months. The prevalence of structural heart disease on TTE was 90%. No ECG criterion was useful to diagnose LVH since no relationship was observed between 9 different ECG signs and increased left ventricular mass index. QRS duration (p = 0.16) and left axis deviation (p = 0.09) were unrelated to reduced left ventricular ejection fraction (LVEF). Eight ECG signs proposed for the diagnosis of the chronic phase of MI demonstrated similar effectiveness, with high specificity and reduced sensitivity. CLBBB is associated with elevated prevalence of cardiac structural disease and hinders the application of common ECG criteria for the diagnosis of LVH, reduced LVEF, or chronic phase of MI. No ECG finding distinguished patients with structural heart disease from those with normal hearts. Electrocardiographic criteria for the diagnosis of MI in the chronic phase are useful when present, but when absent cannot rule it out.

  17. The effect of isolated left bundle branch block on the myocardial velocities and myocardial performance index.

    Science.gov (United States)

    Duzenli, Mehmet Akif; Ozdemir, Kurtulus; Soylu, Ahmet; Aygul, Nazif; Yazici, Mehmet; Tokac, Mehmet

    2008-03-01

    This study was planned in order to investigate the effect of left bundle branch block (LBBB) on myocardial velocities obtained by tissue Doppler echocardiography (TDE) and myocardial performance index (MPI). Subjects with LBBB (n = 61) and age-matched healthy subjects (n = 60) were enrolled in the study. Left ventricular (LV) ejection fraction (EF), mitral inflow velocities (E-wave and A-wave), isovolumetric contraction and relaxation time (ICT and IRT), ejection time (ET), and flow propagation velocity (Vp) were measured by conventional echocardiography. Systolic velocity (Sm), early and late diastolic velocities (Em and Am) and time intervals were measured by TDE. MPI was calculated by the formula (ICT + IRT)/ET. LVEF and mitral E/A ratio were similar in both groups. Vp was lower in the LBBB group than in the control group, whereas the E/Em and the E/Vp ratio was higher. LV Sm and Em/Am ratio were lower in LBBB group. Right ventricular Sm and Em/Am ratio were similar in both groups. LV mean and RV MPI were significantly increased in LBBB group. These findings obtained by TDE show that isolated LBBB impairs the ventricular functions. Both of the LV and RV dysfunctions shown by the new parameters may contribute to increased morbidity and mortality in cases with isolated LBBB.

  18. Myocardial blood flow assessment with {sup 82}rubidium-PET imaging in patients with left bundle branch block

    Energy Technology Data Exchange (ETDEWEB)

    Falcao, Andrea; Chalela, William; Giorgi, Maria Clementina; Imada, Rodrigo; Soares Junior, Jose; Do Val, Renata; Oliveira, Marco Antonio; Izaki, Marisa; Kalil Filho, Roberto; Meneghetti, Jose C., E-mail: andrea.falcao@incor.usp.br [Universidade de Sao Paulo (InCor/USP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Instituto do Coracao

    2015-11-15

    Objectives: Perfusion abnormalities are frequently seen in Single Photon Emission Computed Tomography (SPECT) when a left bundle branch block is present. A few studies have shown decreased coronary flow reserve in the left anterior descending territory, regardless of the presence of coronary artery disease. Objective: we sought to investigate rubidium-82 ({sup 82}Rb) positron emission tomography imaging in the assessment of myocardial blood flow and coronary flow reserve in patients with left bundle branch block. Methods: thirty-eight patients with left bundle branch block (GI), median age 63.5 years, 22 (58%) female, 12 with coronary artery disease (≥70%; GI-A) and 26 with no evidence of significant coronary artery disease (GI-B), underwent rest-dipyridamole stress {sup 82}Rb-positron emission tomography with absolute quantitative flow measurements using Cedars-Sinai software (mL/min/g). The relative myocardial perfusion and left ventricular ejection fraction were assessed in 17 segments. These parameters were compared with those obtained from 30 patients with normal {sup 82}Rb-positron emission tomography studies and without left bundle branch block (GII). Results: stress myocardial blood flow and coronary flow reserve were significantly lower in GI than in GII (p>0.05). The comparison of coronary flow reserve between GI-A and GI-B showed that it was different from the global coronary flow reserve (p<0.05) and the stress flow was significantly lower in the anterior than in the septal wall for both groups. Perfusion abnormalities were more prevalent in GI-A (p=0.06) and the left ventricular ejection fraction was not different between GI-A and GI-B, whereas it was lower in GI than in GII (p<0.001). Conclusion: the data confirm that patients with left bundle branch block had decreased myocardial blood flow and coronary flow reserve and coronary flow reserve assessed by {sup 82}Rb-positron emission tomography imaging may be useful in identifying coronary artery

  19. Effect of PR interval prolongation on long-term outcomes in patients with left bundle branch block vs non-left bundle branch block morphologies undergoing cardiac resynchronization therapy.

    Science.gov (United States)

    Rickard, John; Karim, Mohammad; Baranowski, Bryan; Cantillon, Daniel; Spragg, David; Tang, W H Wilson; Niebauer, Mark; Grimm, Richard; Trulock, Kevin; Wilkoff, Bruce; Varma, Niraj

    2017-10-01

    Although the influence of QRS duration (QRSd) and/or bundle branch block morphology on outcomes of cardiac resynchronization therapy (CRT) have been well studied, the effect of PR interval remains uncertain. The purpose of this study was to evaluate the impact of PR prolongation (PRp) before CRT on long-term outcomes, specifically taking into account bundle branch block morphology and QRSd. We extracted clinical data on consecutive patients undergoing CRT. Multivariate models were constructed to analyze the effect of PRp (≥200 ms) on the combined endpoint of death, heart transplant, or left ventricular assist device. Kaplan-Meier curves were constructed stratifying patients based on bundle branch block and QRSd (dichotomized by 150 ms). Of the 472 patients who met inclusion criteria, 197 (41.7%) had PR interval ≥200 ms. During follow-up (mean 5.1 ± 2.6 years) there were 214 endpoints, of which 109 (23.1%) occurred in patients with PRp. In multivariate analysis, PRp was independently associated with worsened outcomes (hazard ratio 1.34, 95% confidence interval 1.01-1.77, P = .04). When stratified by bundle branch block morphology, PRp was significantly associated with worsened outcomes (log-rank P <.001) in patients with LBBB but not in those with non-LBBB (log-rank P = .55). Among patients with LBBB, stratified by QRSd, patients without PRp had improved outcomes compared to those with PRp independent of QRSd (log-rank P <.001). PRp is an independent predictor of impaired long-term outcome after CRT among patients with LBBB but not in non-LBBB patients. Notably, among LBBB patients, PRp is a more important predictor than QRSd in assessing long-term outcomes. Copyright © 2017. Published by Elsevier Inc.

  20. [Premature outflow tract ventricular contraction combined with complete bundle branch block: the characteristic electrocardiographic and ablation target potential features].

    Science.gov (United States)

    Di, C Y; Wan, Z; Li, K; Ding, Y S; Lin, W H

    2017-12-01

    Objective: To explore the characteristics of electrocardiogram(ECG) and target potential features of premature ventricular contraction (PVC) in patients with complete left/right bundle branch block (CL/RBBB) and compare with those without CL/RBBB. Methods: A retrospective analysis was done in 8 outflow tract PVC patients with CL/RBBB, who successfully underwent radiofrequency ablation from August 2009 to June 2017. According to the bundle branch block chamber, patients were divided into the complete right bundle branch block (CRBBB) group ( n= 4) and the complete left bundle branch block (CLBBB) group ( n= 4). The control group were those who successfully underwent ablation at the same position as the above two groups but without CL/RBBB. The characteristics of ECG and target potential features were compared among groups. Results: One case in the CRBBB group was successfully ablated in the great cardiac vein with precordial R/S>1 transition at V(1) and one case in the CLBBB group was successfully ablated in the right coronary cusp with precordial R/S>1 transition at V(2), while other 6 cases were all with precordial R/S>1 transition at lead V(4). Precordial R/S>1 transition was not later than sinus rhythm (SR) in the CLBBB group. No statistical difference was found in the QRS complex duration between SR and PVC in the CL/RBBB patients [(134.38±23.80)ms vs (156.75±25.93)ms, P> 0.05], while statistical difference was shown in the control group [(92.63±5.76)ms vs (140.25±15.97)ms, PBundle branch block can lead to misjudgment of PVC origin with CL/RBBB during sinus rhythm, thus the origin chamber of the PVC should be determined according to the mapping and ablation result.

  1. A Novel Pacing Strategy With Low and Stable Output: Pacing the Left Bundle Branch Immediately Beyond the Conduction Block.

    Science.gov (United States)

    Huang, Weijian; Su, Lan; Wu, Shengjie; Xu, Lei; Xiao, Fangyi; Zhou, Xiaohong; Ellenbogen, Kenneth A

    2017-12-01

    This report demonstrates the feasibility of pacing the left bundle branch (LBB) immediately beyond the conduction block to functionally restore the impaired His-Purkinje conduction system in a patient with heart failure and left bundle branch block (LBBB). The pacing required only a low pacing output (0.5 volts/0.5 ms) to correct the LBBB with accompanying right BBB on the electrocardiogram. Over 1-year of follow-up, the patient had a significant improvement in clinical outcome and echocardiographic measurements. The case shows a novel pacing strategy for patients with BBB that affects many patients with heart failure. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  2. Exercise Induced Left Bundle Branch Block Treated with Cardiac Rehabilitation: A Case Report and a Review of the Literature

    Science.gov (United States)

    Anderson, Nathan S.; Ramirez, Alexies; Slim, Ahmad; Malik, Jamil

    2014-01-01

    Exercise induced bundle branch block is a rare observation in exercise testing, accounting for 0.5 percent of exercise tests. The best treatment of this condition and its association with coronary disease remain unclear. We describe a case associated with normal coronary arteries which was successfully treated with exercise training. While this treatment has been used previously, our case has a longer followup than previously reported and demonstrates that the treatment is not durable in the absence of continued exercise. PMID:24716091

  3. Prognostic Implication of the QRS Axis and its Association with Myocardial Scarring in Patients with Left Bundle Branch Block

    OpenAIRE

    Park, Chan Soon; Cha, Myung-jin; Choi, Eue-Keun; Oh, Seil

    2017-01-01

    Background and Objectives Left bundle branch block (LBBB) with left axis deviation (LAD) has a worse prognosis than LBBB with a normal axis, and myocardial dysfunction has been suggested as a cause of left axis deviation. This study investigated the prognostic significance of the QRS axis in patients with LBBB and analyzed its relationship with the amount of myocardial scarring. Subjects and Methods A total of 829 patients were diagnosed with LBBB at Seoul National University Hospital from Oc...

  4. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

    Science.gov (United States)

    Cabeda, Estêvan Vieira; Falcão, Andréa Maria Gomes; Soares Jr., José; Rochitte, Carlos Eduardo; Nomura, César Higa; Ávila, Luiz Francisco Rodrigues; Parga, José Rodrigues

    2015-01-01

    Background Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee. Results The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB. PMID:26421532

  5. Prognostic and clinical significance of newly acquired complete right bundle branch block in Japan Airline pilots.

    Science.gov (United States)

    Taniguchi, Masayuki; Nakano, Hajime; Kuwahara, Koichiro; Masuda, Izuru; Okawa, Yasuhiro; Miyazaki, Hiroshi; Okoshi, Hirofumi; Kaji, Masanobu; Noguchi, Yoshiko; Asukata, Ichiro

    2003-01-01

    The purpose of this study was to evaluate the prognostic and clinical significance of newly acquired complete right bundle branch block (CRBBB) in airline pilots. This study included pilots with acquired CRBBB, identified from a group of over 2,700 Japan Airline pilots. When the pilots applied for employment, a past medical history, physical examination, electrocardiogram, and chest radiograph were obtained. The pilots with ECG abnormality including CRBBB were not included in the study because of hiring requirements. Thirty-six pilots with CRBBB were identified between 1983 and 2002. All pilots with CRBBB were evaluated for the presence of ischemic heart disease by treadmill exercise testing, echocardiogram and exercise thallium scintigraphy. Twelve individuals underwent coronary angiography. The mean age of pilots was 44.4 +/- 5.8 years. The mean observation period was 10.9 +/- 5.7 years. For each of the 36 study subjects, Holter electrocardiogram and echocardiogram were obtained every 6 months after the CRBBB was detected. Exercise stress testing was performed every year. Exercise thallium scintigraphy was performed every 2 years to detect ischemic heart disease. During the observation period, two pilots stopped flying temporarily because of frequent ventricular premature beats and one pilot stopped flying permanentaly because of atrial fibrillation. During the follow-up period, no cardiovascular events were observed in pilots with CRBBB who had no underlying ischemic heart disease. Acquired CRBBB does not confer a poor prognosis, particularly in young men working as a pilot if there is no evidence of ischemia on exercise stress testing, echocardiography and exercise thallium scintigraphy.

  6. Cardiovascular magnetic resonance features of mechanical dyssynchrony in patients with left bundle branch block.

    Science.gov (United States)

    Revah, Giselle; Wu, Vincent; Huntjens, Peter R; Piekarski, Eve; Chyou, Janice Y; Axel, Leon

    2016-09-01

    Patients with left bundle branch block (LBBB) can exhibit mechanical dyssynchrony which may contribute to heart failure; such patients may benefit from cardiac resynchronization treatment (CRT). While cardiac magnetic resonance imaging (CMR) has become a common part of heart failure work-up, CMR features of mechanical dyssynchrony in patients with LBBB have not been well characterized. This study aims to investigate the potential of CMR to characterize mechanical features of LBBB. CMR examinations from 43 patients with LBBB on their electrocardiogram, but without significant focal structural abnormalities, and from 43 age- and gender-matched normal controls were retrospectively reviewed. The following mechanical features of LBBB were evaluated: septal flash (SF), apical rocking (AR), delayed aortic valve opening measured relative to both end-diastole (AVO ED ) and pulmonic valve opening (AVO PVO ), delayed left-ventricular (LV) free-wall contraction, and curvatures of the septum and LV free-wall. Septal displacement curves were also generated, using feature-tracking techniques. The echocardiographic findings of LBBB were also reviewed in those subjects for whom they were available. LBBB was significantly associated with the presence of SF and AR; within the LBBB group, 79 % had SF and 65 % had AR. Delayed AVO ED , AVO PVO , and delayed LV free-wall contraction were significantly associated with LBBB. AVO ED and AVO PVO positively correlated with QRS duration and negatively correlated with ejection fraction. Hearts with electrocardiographic evidence of LBBB showed lower septal-to-LV free-wall curvature ratios at end-diastole compared to normal controls. CMR can be used to identify and evaluate mechanical dyssynchrony in patients with LBBB. None of the normal controls showed the mechanical features associated with LBBB. Moreover, not all patients with LBBB showed the same degree of mechanical dyssynchrony, which could have implications for CRT.

  7. Left bundle branch block in Duchenne muscular dystrophy: Prevalence, genetic relationship and prognosis.

    Science.gov (United States)

    Fayssoil, Abdallah; Ben Yaou, Rabah; Ogna, Adam; Chaffaut, Cendrine; Leturcq, France; Nardi, Olivier; Wahbi, Karim; Duboc, Denis; Lofaso, Frederic; Prigent, Helene; Clair, Bernard; Crenn, Pascal; Nicolas, Guillaume; Laforet, Pascal; Behin, Anthony; Chevret, Sylvie; Orlikowski, David; Annane, Djillali

    2018-01-01

    Duchenne muscular dystrophy (DMD) is an inherited myogenic disorder due to mutations in the dystrophin gene on chromosome Xp21.1. We designed this study to determine the prevalence of left bundle branch block (LBBB), whether there is a relationship between LBBB and genetic pattern, and to assess predictive factors for acute cardiac events and mortality in adult DMD patients. We reviewed the charts of DMD followed at the Home Mechanical Ventilation Unit of the Raymond Poincare University Hospital. A total of 121 patients, aged from 18 to 41 years have been included in our study. Median vital capacity (VC) was 12% [7; 19.5] of predicted. Almost all patients were on home mechanical ventilation (95%). LBBB was present in 15 patients (13%); among them, 10 disclosed exonic deletions. After a median follow up of 6 years, 21 patients (17%) experienced acute heart failure (AHF), 7 patients (6%) supraventricular arrhythmia, 3 patients (2.4%) ventricular tachycardia, 4 patients (3%) significant electrical disturbances. LBBB was significantly associated with cardiac events (OR = 12.7; 95%CI [3.78-42.7]; p <0.0001) and mortality (OR = 4.4; 95%CI [1.44-13.7]; p 0.009). Presence of residual dystrophin protein was not associated with significant less cardiac events. Age and LVEF were also predictive factors for cardiac events and mortality. LBBB is relatively frequent in DMD and is a major predictive factor for cardiac events and mortality. Presence of residual dystrophin protein was not associated with a lower incidence of cardiac events.

  8. New formula for evaluation of the QT interval in patients with left bundle branch block.

    Science.gov (United States)

    Bogossian, Harilaos; Frommeyer, Gerrit; Ninios, Ilias; Hasan, Fuad; Nguyen, Quy Suu; Karosiene, Zana; Mijic, Dejan; Kloppe, Axel; Suleiman, Hawal; Bandorski, Dirk; Seyfarth, Melchior; Lemke, Bernd; Eckardt, Lars; Zarse, Markus

    2014-12-01

    Left bundle branch block (LBBB) and QT prolongation both are associated with a worse prognosis. LBBB lengthens the QT interval. To date it is not known whether QT prolongation during LBBB differs in repolarization from QT prolongation during narrow QRS. The purpose of the present proof-of-concept-study was to develop a formula that allows comparison of the adjusted QT interval during LBBB with reference values and thereby allows interpretation of the QT interval irrespective of QRS widening. Sixty consecutive patients with sinus rhythm (SR) and narrow QRS underwent electrophysiologic study for ablation. In all patients, the intrinsic QRS ,QT, and JT times were measured during SR, and ventricular pacing from both the right ventricular apex (RVA) and the right ventricular outflow tract (RVOT) caused LBBB. We determined prolongation of the QT during as compared to SR (ΔQT). ΔQT was then divided by the QRS length during pacing QRS (QRSb). This describes the percentage of the QRS duration at LBBB, which must be subtracted from the measured QT (QTb) to determine the modified QT interval (QTm). The ratio of ΔQT to paced QRS was calculated as 48.3% (RVA) and 48.8% (RVOT) (mean 48.5%). The ratio intrinsic of JTi to paced JT was 1.0055 (RVA) and 1.0087 (RVOT). There was no significant difference in intrinsic JT vs paced JT (P = .2). Right ventricular pacing causes prolongation of the QT due to a paced LBBB without prolongation of the JT time. In our study, we showed that QT prolongation caused by LBBB constitutes 48.5% of the QRS width. This is the value that must be subtracted from the measured QT in LBBB in order to estimate the modified QT. Thus, the resulting formula for "modified QT" estimation in LBBB is QTm = QTb - 48.5% * (QRSb). Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  9. Exercise left ventricular ejection fraction predicts events in right bundle branch block.

    Science.gov (United States)

    Peteiro, Jesús; Bouzas-Mosquera, Alberto; Broullón, Javier; Yañez, Juan; Martinez, Dolores; Vazquez, Jose Manuel

    2016-01-01

    Interpretation of the electrocardiogram (ECG) during exercise is not easy in patients with right bundle branch block (RBBB). Also, the value of exercise echocardiography (ExE) for predicting outcome in them has not been addressed. We sought to assess its prognostic value in patients with RBBB and known/suspected coronary disease. Retrospective analysis of data on 703 patients with RBBB who were submitted to a clinically-indicated ExE. The end points were overall mortality and combined myocardial infarction and cardiovascular mortality. During follow-up (4.1 ± 4.5 years) there were 130 deaths and 108 combined events. Independent predictors of combined events were history of coronary artery disease (hazard ratio [HR] = 2.37, 95% Confidence Interval [CI] = 1.24-4.52, p = 0.009) resting wall motion score index (HR = 2.14, 95% CI = 1.12-4.10, p = 0.02), metabolic equivalents (HR = 0.89, 95% CI = 0.93-0.97, p = 0.007), Δ in double product with exercise (HR = 0.96, 95% CI = 0.92-1.00, p = 0.036) and Δ in left ventricular ejection fraction (LVEF) with exercise (HR = 0.97, 95% CI = 0.94-0.99, p = 0.01). Neither positive clinical nor ECG exercise testing was predictive. Combined event rates were 3.3% in patients with ΔLVEF > 5%, 4.7% in those with ΔLVEF between 1-5% and 8.2% in those with no increase (Δ < 1%). A decrease in LVEF during exercise is predictive of serious events in patients with RBBB.

  10. Automatic QRS Selvester scoring system in patients with left bundle branch block.

    Science.gov (United States)

    Xia, Xiaojuan; Wieslander, Björn; Strauss, David G; Wagner, Galen S; Zareba, Wojciech; Moss, Arthur J; Couderc, Jean-Philippe

    2016-02-01

    The Selvester QRS scoring system uses quantitative criteria from the standard 12-lead electrocardiogram (ECG) to estimate the myocardial scar size of patients, including those with left bundle branch block (LBBB). Automation of the scoring system could facilitate the clinical use of this technique which requires a set of multiple QRS patterns to be identified and measured. We developed a series of algorithms to automatically detect and measure the QRS parameters required for Selvester scoring. The 'QUantitative and Automatic REport of Selvester Score' was designed specifically for the analysis of ECGs from patients meeting new strict criteria for complete LBBB. The algorithms were designed using a training (n = 36) and a validation (n = 180) set of ECGs, consisting of signal-averaged 12-lead ECGs (1000 Hz sampling) recorded from 216 LBBB patients from the MADIT-CRT. We assessed the performance of the methods using expert manually adjudicated ECGs. The average of absolute differences between automatic and adjudicated Selvester scoring was 1.2 ± 1.5 points. The range of average differences for continuous measurements of wave locations and interval durations varied between 0 and 6 ms. Erroneous detection of Q, R, S, R', and S' waves (oversensed or missed) were 3, 1, 1, 16, and 6%, respectively. Seven percent of notches detected in the first 40 ms were misdetected. We propose an efficient computerized method for the automatic measurement of the Selvester score in patients with the strict LBBB. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  11. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block

    Directory of Open Access Journals (Sweden)

    Estêvan Vieira Cabeda

    2015-01-01

    Full Text Available AbstractBackground:Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB.Objective:To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA (stenosis ≥ 70% as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA and compare the results with those of single photon emission computed tomography (SPECT myocardial perfusion scintigraphy.Methods:Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution’s ethics committee.Results:The patients’ mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001. The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001. In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001.Conclusion:The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB.

  12. Validation of an automatic diagnosis of strict left bundle branch block criteria using 12-lead electrocardiograms.

    Science.gov (United States)

    Xia, Xiaojuan; Ruwald, Anne-Christine; Ruwald, Martin H; Ugoeke, Nene; Szepietowska, Barbara; Kutyifa, Valentina; Aktas, Mehmet K; Thomsen, Poul Erik B; Zareba, Wojciech; Moss, Arthur J; Couderc, Jean-Philippe

    2017-03-01

    Strict left bundle branch block (LBBB) criteria were recently proposed to identify LBBB patients to benefit most from cardiac resynchronization therapy (CRT). The aim of our study was to automate identification of strict LBBB in order to facilitate its broader application. We developed a series of algorithms to automatically detect and measure parameters required for strict LBBB criteria and proposed a definition of QRS notch detection. The algorithms were developed using training (n = 20) and validation (n = 592) sets consisting of signal-averaged 12-lead ECGs (1,000 Hz sampling) recorded from 612 LBBB patients from Multicenter Automatic Defibrillator Implantation Trial-CRT. Four trained clinicians independently performed adjudication on 148 different ECGs for comparing automatic and manually adjudicated results, in addition to 13 ECGs for evaluation of intraobserver variability and 32 ECGs for interobserver variability. We assessed the performance of the automated algorithms using manually adjudicated ECGs as references. Overall sensitivity and specificity for detecting strict LBBB were 95% and 86%, respectively. The mean absolute deviation (MAD) of QRS duration and notch/slur locations for the automated method versus the manual method was below 1 ms, and MAD values were lower than 2 ms for interobserver and intraobserver variability. Sensitivity and specificity for detecting notch and slur locations were 87% and 96% for notches and 78% and 90% for slurs using the automatic method. In addition 95% and 93% agreements for notches and 90% and 88% agreements for slurs were reached for intra- and interobserver. The proposed algorithms automatically measure QRS features for the diagnosis of strict LBBB. Our study shows good performance in reference to manual results. © 2016 Wiley Periodicals, Inc.

  13. Left bundle branch block in Duchenne muscular dystrophy: Prevalence, genetic relationship and prognosis

    Science.gov (United States)

    Ben Yaou, Rabah; Ogna, Adam; Chaffaut, Cendrine; Leturcq, France; Nardi, Olivier; Wahbi, Karim; Duboc, Denis; Lofaso, Frederic; Prigent, Helene; Clair, Bernard; Crenn, Pascal; Nicolas, Guillaume; Laforet, Pascal; Behin, Anthony; Chevret, Sylvie; Orlikowski, David; Annane, Djillali

    2018-01-01

    Background Duchenne muscular dystrophy (DMD) is an inherited myogenic disorder due to mutations in the dystrophin gene on chromosome Xp21.1. We designed this study to determine the prevalence of left bundle branch block (LBBB), whether there is a relationship between LBBB and genetic pattern, and to assess predictive factors for acute cardiac events and mortality in adult DMD patients. Methods We reviewed the charts of DMD followed at the Home Mechanical Ventilation Unit of the Raymond Poincare University Hospital. Results A total of 121 patients, aged from 18 to 41 years have been included in our study. Median vital capacity (VC) was 12% [7; 19.5] of predicted. Almost all patients were on home mechanical ventilation (95%). LBBB was present in 15 patients (13%); among them, 10 disclosed exonic deletions. After a median follow up of 6 years, 21 patients (17%) experienced acute heart failure (AHF), 7 patients (6%) supraventricular arrhythmia, 3 patients (2.4%) ventricular tachycardia, 4 patients (3%) significant electrical disturbances. LBBB was significantly associated with cardiac events (OR = 12.7; 95%CI [3.78–42.7]; p <0.0001) and mortality (OR = 4.4; 95%CI [1.44–13.7]; p 0.009). Presence of residual dystrophin protein was not associated with significant less cardiac events. Age and LVEF were also predictive factors for cardiac events and mortality. Conclusion LBBB is relatively frequent in DMD and is a major predictive factor for cardiac events and mortality. Presence of residual dystrophin protein was not associated with a lower incidence of cardiac events. PMID:29304097

  14. Transient left bundle branch block induced by left-sided cardiac catheterization in patients without pre-existing conduction abnormalities.

    Science.gov (United States)

    Shimamoto, T; Nakata, Y; Sumiyoshi, M; Ogura, S; Takaya, J; Sakurai, H; Yamaguchi, H

    1998-02-01

    A traumatic left bundle branch block (LBBB) is uncommon in a patient with intact atrioventricular conduction. Three of our patients developed LBBB during a left-sided catheterization. Two patients suffered from angina pectoris and the other had an abdominal aneurysm. Two of them had a history of hypertension. None of the patients had ever shown any conduction abnormalities before the catheterization. The electrocardiogram just before the examination was normal in all 3 patients. LBBB was observed when a catheter was introduced into the left ventricle, and lasted 2--4 min without significant change in heart rates. Examination revealed no significant stenosis proximal to the first septal perforator and normal left ventricular contraction in all patients. One patient developed permanent LBBB 14 months later. Catheter-induced LBBB may occur easily with certain anatomical characteristics of the left bundle branch or the distal His bundle, with or without some concealed damage to the conduction system. It is important to keep this complication in mind and to pay adequate attention to patients' electrocardiograms as well as their angiographical findings, especially in those with pre-existing right bundle branch block.

  15. Protective Role of False Tendon in Subjects with Left Bundle Branch Block: A Virtual Population Study

    Science.gov (United States)

    Lange, Matthias; Di Marco, Luigi Yuri; Lekadir, Karim; Lassila, Toni; Frangi, Alejandro F.

    2016-01-01

    False tendons (FTs) are fibrous or fibromuscular bands that can be found in both the normal and abnormal human heart in various anatomical forms depending on their attachment points, tissue types, and geometrical properties. While FTs are widely considered to affect the function of the heart, their specific roles remain largely unclear and unexplored. In this paper, we present an in silico study of the ventricular activation time of the human heart in the presence of FTs. This study presents the first computational model of the human heart that includes a FT, Purkinje network, and papillary muscles. Based on this model, we perform simulations to investigate the effect of different types of FTs on hearts with the electrical conduction abnormality of a left bundle branch block (LBBB). We employ a virtual population of 70 human hearts derived from a statistical atlas, and run a total of 560 simulations to assess ventricular activation time with different FT configurations. The obtained results indicate that, in the presence of a LBBB, the FT reduces the total activation time that is abnormally augmented due to a branch block, to such an extent that surgical implant of cardiac resynchronisation devices might not be recommended by international guidelines. Specifically, the simulation results show that FTs reduce the QRS duration at least 10 ms in 80% of hearts, and up to 45 ms for FTs connecting to the ventricular free wall, suggesting a significant reduction of cardiovascular mortality risk. In further simulation studies we show the reduction in the QRS duration is more sensitive to the shape of the heart then the size of the heart or the exact location of the FT. Finally, the model suggests that FTs may contribute to reducing the activation time difference between the left and right ventricles from 12 ms to 4 ms. We conclude that FTs may provide an alternative conduction pathway that compensates for the propagation delay caused by the LBBB. Further investigation is

  16. Complete left bundle branch block with left QRS axis deviation: defining its clinical importance.

    Science.gov (United States)

    Parharidis, G; Nouskas, J; Efthimiadis, G; Styliadis, J; Gemitzis, K; Hatzimiltiadis, S; Karoulas, T; Tsifodimos, D

    1997-01-01

    Aim of this study was to elucidate the diagnostic significance of left axis deviation (LAD) in patients (pts) with chronic (> 6 months) left bundle branch block (LBBB). We retrospectively studied 2094 consecutive pts who underwent cardiac catheterization. All pts had left heart catheterization and coronary angiography, whereas right heart catheterization or endomyocardial biopsy were performed on indication. Our study group consisted of 43 pts with LBBB (29 men, 14 women, mean age 60.3 +/- 7.9 years). Pts with acute myocardial infarction or prior high degree AV-block were excluded. Initial evaluation included history, physical examination, chest X-ray, serial ECGs, 2D-echo and Doppler studies. ECG-criteria for LBBB were a QRS duration of > 0.12 secs, a predominantly negative QRS deflection in V1 and a widened R-wave in V6. LAD was considered present when the mean frontal QRS axis was between -30 degrees and -90 degrees. The mean frontal QRS axis was considered normal if it was between -29 degrees and +90 degrees. Twenty-nine pts had normal axis and 14 had LAD. According to angiographic data, among coronary disease pts, 12 (31.48%) had normal axis and 4 (28.57%) LAD (p = 0.041). Among mitral valve disease pts, 3 (10.35%) had normal axis and none LAD. Among pts with aortic valve disease, I (3.45%) had normal axis and 8 (57.15%) LAD (p = 0.0001). Among pts with dilated cardiomyopathy, 2 (6.9%) had normal axis and 1 (7.14%) LAD. Among pts with no organic heart disease, 11 (37.93%) had normal axis and 1 (7.14%) LAD (p = 0.035). The presence of LAD had a 41.9% sensitivity and a 91.6% specificity for the presence of organic heart disease. These findings point towards a statistically significant difference in the presence of organic heart disease in LBBB pts with LAD compared to normals. Aortic valve disease in LBBB pts seems to be frequently accompanied by LAD.

  17. Usefulness of QRS axis change to predict mortality in patients with left bundle branch block.

    Science.gov (United States)

    Patel, Parin J; Verdino, Ralph J

    2013-08-01

    QRS duration correlates with poor prognosis in patients with left bundle branch block (LBBB), but the importance of left-axis deviation (LAD) is not well established. To determine if LAD confers a mortality risk in patients with LBBB, a single-center, retrospective, population-based cohort study was conducted. Included were all patients at 1 hospital with LBBB on electrocardiography from 1995 to 2005 over a 17-year follow-up period (n = 2,794, median follow-up duration 20 months, interquartile range 6 to 64). Half of all patients with LBBB had LAD. The all-cause mortality rate in the entire cohort was 15%. LAD was not associated with mortality, either as a single outcome (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.88 to 1.3, p = 0.50) or in time-to-event analysis (p = 0.40). Significant risk factors for mortality included high creatinine (OR 1.2, 95% CI 1.1 to 1.3), low hemoglobin (OR 1.2, 95% CI 1.1 to 1.3), history of atrial fibrillation (OR 1.6, 95% CI 1.3 to 2.1), electrocardiographic evidence of previous infarct (OR 1.5, 95% CI 1.2 to 1.9), and history of ventricular tachycardia (OR 1.4, 95% CI 1.0 to 1.9). On bivariate analysis, LAD was associated with atrial fibrillation, ventricular tachycardia, age, and congestive heart failure. Patients with LBBB who converted from normal axis to LAD had significantly higher mortality in time-to-event analysis (p = 0.02). In conclusion, in patients with LBBB, LAD does not confer significant mortality risk. However, those with normal axis who developed LAD during the study period had significantly higher mortality. Perhaps when LBBB and LAD develop concurrently, there is no increased risk over baseline LBBB development, but it may herald a worse prognosis if LAD develops against the background of previous LBBB, from an unknown mechanism. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy?

    Science.gov (United States)

    Widimsky, Petr; Roháč, Filip; Štásek, Josef; Kala, Petr; Rokyta, Richard; Kuzmanov, Boyko; Jakl, Martin; Poloczek, Martin; Kaňovský, Jan; Bernat, Ivo; Hlinomaz, Ota; Bělohlávek, Jan; Král, Ales; Mrázek, Vratislav; Grigorov, Vladimir; Djambazov, Slaveyko; Petr, Robert; Knot, Jiri; Bílková, Dana; Fischerová, Michaela; Vondrák, Karel; Malý, Marek; Lorencová, Alena

    2012-01-01

    Aims The current guidelines recommend reperfusion therapy in acute myocardial infarction (AMI) with ST-segment elevation or left bundle branch block (LBBB). Surprisingly, the right bundle branch block (RBBB) is not listed as an indication for reperfusion therapy. This study analysed patients with AMI presenting with RBBB [with or without left anterior hemiblock (LAH) or left posterior hemiblock (LPH)] and compared them with those presenting with LBBB or with other electrocardiographic (ECG) patterns. The aim was to describe angiographic patterns and primary angioplasty use in AMI patients with RBBB. Methods and results A cohort of 6742 patients with AMI admitted to eight participating hospitals was analysed. Baseline clinical characteristics, ECG patterns, coronary angiographic, and echocardiographic data were correlated with the reperfusion therapies used and with in-hospital outcomes. Right bundle branch block was present in 6.3% of AMI patients: 2.8% had RBBB alone, 3.2% had RBBB + LAH, and 0.3% had RBBB + LPH. TIMI flow 0 in the infarct-related artery was present in 51.7% of RBBB patients vs. 39.4% of LBBB patients (P = 0.023). Primary percutaneous coronary intervention (PCI) was performed in 80.1% of RBBB patients vs. 68.3% of LBBB patients (Pblocks had the highest (LBBB 15.8% and RBBB 15.4%) incidence of cardiogenic shock from all ECG subgroups. Percutaneous coronary intervention was done more frequently (84.8%) in patients with new or presumably new RBBB when compared with other patients with blocks (old RBBB 66.0%, old LBBB 62.3%, new or presumably new LBBB 73.0%). In-hospital mortality was highest (18.8%) among patients presenting with new or presumably new RBBB, followed by new or presumably new LBBB (13.2%), old LBBB (10.1%), and old RBBB (6.4%). Among 35 patients with acute left main coronary artery occlusion, 26% presented with RBBB (mostly with LAH) on the admission ECG. Conclusion Acute myocardial infarction with RBBB is frequently caused by the

  19. Transcatheter Heart Valve Selection and Permanent Pacemaker Implantation in Patients With Pre-Existent Right Bundle Branch Block.

    Science.gov (United States)

    van Gils, Lennart; Tchetche, Didier; Lhermusier, Thibault; Abawi, Masieh; Dumonteil, Nicolas; Rodriguez Olivares, Ramón; Molina-Martin de Nicolas, Javier; Stella, Pieter R; Carrié, Didier; De Jaegere, Peter P; Van Mieghem, Nicolas M

    2017-03-03

    Right bundle branch block is an established predictor for new conduction disturbances and need for a permanent pacemaker (PPM) after transcatheter aortic valve replacement. The aim of the study was to evaluate the absolute rates of transcatheter aortic valve replacement related PPM implantations in patients with pre-existent right bundle branch block and categorize for different transcatheter heart valves. We pooled data on 306 transcatheter aortic valve replacement patients from 4 high-volume centers in Europe and selected those with right bundle branch block at baseline without a previously implanted PPM. Logistic regression was used to evaluate whether PPM rate differed among transcatheter heart valves after adjustment for confounders. Mean age was 83±7 years and 63% were male. Median Society of Thoracic Surgeons score was 6.3 (interquartile range, 4.1-10.2). The following transcatheter valve designs were used: Medtronic CoreValve (n=130; Medtronic, Minneapolis, MN); Edwards Sapien XT (ES-XT; n=124) and Edwards Sapien 3 (ES-3; n=32; Edwards Lifesciences, Irvine, CA); and Boston Scientific Lotus (n=20; Boston Scientific Corporation, Marlborough, MA). Overall permanent pacemaker implantation rate post-transcatheter aortic valve replacement was 41%, and per valve design: 75% with Lotus, 46% with CoreValve, 32% with ES-XT, and 34% with ES-3. The indication for PPM implantation was total atrioventricular block in 98% of the cases. Lotus was associated with a higher PPM rate than all other valves. PPM rate did not differ between ES-XT and ES-3. Ventricular paced rhythm at 30-day and 1-year follow-up was present in 81% at 89%, respectively. Right bundle branch block at baseline is associated with a high incidence of PPM implantation for all transcatheter heart valves. PPM rate was highest for Lotus and lowest for ES-XT and ES-3. Pacemaker dependency remained high during follow-up. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by

  20. Exercise Induced Left Bundle Branch Block Treated with Cardiac Rehabilitation: A Case Report and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Nathan S. Anderson

    2014-01-01

    Full Text Available Exercise induced bundle branch block is a rare observation in exercise testing, accounting for 0.5 percent of exercise tests. The best treatment of this condition and its association with coronary disease remain unclear. We describe a case associated with normal coronary arteries which was successfully treated with exercise training. While this treatment has been used previously, our case has a longer followup than previously reported and demonstrates that the treatment is not durable in the absence of continued exercise.

  1. Left ventricular performance during triggered left ventricular pacing in patients with cardiac resynchronization therapy and left bundle branch block

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2016-01-01

    complex >150 ms, QRS complex narrowing under CRT, and sinus rhythm were included ≥3 months after CRT implantation. Echocardiographic assessment of left ventricular ejection fraction (LVEF), global peak systolic longitudinal strain (GLS), and contraction pattern by 2D strain was performed during intrinsic......PURPOSE: To assess the acute effect of triggered left ventricular pacing (tLVp) on left ventricular performance and contraction pattern in patients with heart failure, left bundle branch block (LBBB), and cardiac resynchronization therapy (CRT). METHODS: Twenty-three patients with pre-implant QRS...

  2. Factors determining the magnitude of the pre-ejection leftward septal motion in left bundle branch block.

    Science.gov (United States)

    Remme, Espen W; Niederer, Steven; Gjesdal, Ola; Russell, Kristoffer; Hyde, Eoin R; Smith, Nicolas; Smiseth, Otto A

    2016-12-01

    An abnormal large leftward septal motion prior to ejection is frequently observed in left bundle branch block (LBBB) patients. This motion has been proposed as a predictor of response to cardiac resynchronization therapy (CRT). Our goal was to investigate factors that influence its magnitude. Left (LVP) and right ventricular (RVP) pressures and left ventricular (LV) volume were measured in eight canines. After induction of LBBB, LVP and, hence, the transmural septal pressure (P LV-RV = LVP-RVP) increased more slowly (P bundle branch block lowers afterload against pre-ejection septal contraction, expressed as slowed rise of P LV-RV , which is a main cause and determinant of the magnitude of leftward septal motion. The motion may be small or absent due to septal infarct, impaired global or RV contractility or RV volume overload, which should be kept in mind if this motion is to be used in evaluation of CRT response. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  3. Cardiac resynchronization therapy for heart failure induced by left bundle branch block after transcatheter closure of ventricular septal defect

    Science.gov (United States)

    Du, Rong-Zeng; Qian, Jun; Wu, Jun; Liang, Yi; Chen, Guang-Hua; Sun, Tao; Zhou, Ye; Zhao, Yang; Yan, Jin-Chuan

    2014-01-01

    A 54-year-old female patient with congenital heart disease had a persistent complete left bundle branch block three months after closure by an Amplatzer ventricular septal defect occluder. Nine months later, the patient suffered from chest distress, palpitation, and sweating at daily activities, and her 6-min walk distance decreased significantly (155 m). Her echocardiography showed increased left ventricular end-diastolic diameter with left ventricular ejection fraction of 37%. Her symptoms reduced significantly one week after received cardiac resynchronization therapy. She had no symptoms at daily activities, and her echo showed left ventricular ejection fraction of 46% and 53%. Moreover, left ventricular end-diastolic diameter decreased 6 and 10 months after cardiac resynchronization therapy, and 6-min walk distance remarkably increased. This case demonstrated that persistent complete left bundle branch block for nine months after transcatheter closure with ventricular septal defect Amplatzer occluder could lead to left ventricular enlargement and a significant decrease in left ventricular systolic function. Cardiac resynchronization therapy decreased left ventricular end-diastolic diameter and increased left ventricular ejection fraction, thereby improving the patient's heart functions. PMID:25593586

  4. [Right Bundle Branch Block, Left Bundle Branch Block, Pace Maker in Case of Acute Coronary Syndrome - is the ECG of any Value?

    Science.gov (United States)

    Grautoff, Steffen

    2017-01-01

    The 12 lead ECG is difficult to evaluate if there is a persistent right or even left bundle block or a pace maker continually stimulating the right ventricle. Despite these pre-existing or new ECG changes it might still be possible to detect variations which can hint to an ST-elevation myocardial infarction (STEMI). Diagnosing significant ST elevations in a case of right bundle block is not very challenging. If the ECG shows a left bundle block the modified Sgarbossa criteria should be used for evaluation. These criteria can also be used in a pace maker ECG. If a patient is not pacemaker-dependent the stimulation can be paused transiently to reveal changes of the ST segment. At first medical contact it can be very important to assess these changes correctly in order to classify the ECG as a STEMI. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Left ventricular regional contraction abnormalities by echocardiographic speckle tracking in combined right bundle branch with left anterior fascicular block compared to left bundle branch block

    DEFF Research Database (Denmark)

    Leeters, Irene P M; Davis, Ashlee; Zusterzeel, Robbert

    2016-01-01

    patterns compared to other groups (LBBB: p=0.042, no-block: p=0.012). In addition, RBBB+LAFB patients had more scar than LBBB patients (9.9% vs 3.4%, p=0.041), and the average amount of scar in each wall was also higher in RBBB+LAFB (... to LBBB. Factors that might alter strain patterns in RBBB+LAFB, including the detailed presence or absence of LV scar and coexisting block of the central fascicle, should be assessed in future studies....

  6. Left ventricular regional contraction abnormalities by echocardiographic speckle tracking in combined right bundle branch with left anterior fascicular block compared to left bundle branch block.

    Science.gov (United States)

    Leeters, Irene P M; Davis, Ashlee; Zusterzeel, Robbert; Atwater, Brett; Risum, Niels; Søgaard, Peter; Klem, Igor; Nijveldt, Robin; Wagner, Galen S; Gorgels, Anton P M; Kisslo, Joseph

    2016-01-01

    In contrast to LBBB patients less is known about patients with RBBB+LAFB regarding LV contractile abnormalities and the potential role of CRT. This study investigated whether patients with RBBB+LAFB morphology have echocardiographic mechanical strain abnormalities between the inferior and anterior LV walls, similar to abnormalities between septal and lateral walls in LBBB. Ten healthy volunteers with no-BBB, 28 LBBB and 28 RBBB+LAFB heart failure patients were included in this retrospective study. Two-dimensional regional-strains were obtained by speckle-tracking. Scar was assessed by CMR. Response on echo was defined as normal, classical, borderline or other pattern. The number of classical patterns in LBBB was significantly higher than in RBBB+LAFB and no-BBB groups (pblock: p=0.012). In addition, RBBB+LAFB patients had more scar than LBBB patients (9.9% vs 3.4%, p=0.041), and the average amount of scar in each wall was also higher in RBBB+LAFB (block of the central fascicle, should be assessed in future studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Tachycardia-dependent bilateral bundle branch block in ischemic heart disease with systolic dysfunction: case report and review of prognostic implications.

    Science.gov (United States)

    Ferrando-Castagnetto, Federico; Vidal, Alejandro; Ricca-Mallada, Roberto; Nogara, Romina; Marichal, Pablo; Martínez, Fabián

    2015-10-16

    A proper characterization of frequency-dependent bundle branch blocks can provide useful prognostic information in some clinical situations. Often, this physiological event may be due to an extensive damage of infrahisian system, which poses a high risk of developing advanced atrioventricular block requiring pacemaker implantation. We describe the case of a 62 year-old man with chronic ischemic heart disease who exhibited alternating tachycardia-dependent bundle branch block during stress test. We discuss the main prognostic implications of this unusual event in the context of systolic dysfunction.

  8. Development of a swine model of left bundle branch block for experimental studies of cardiac resynchronization therapy.

    Science.gov (United States)

    Rigol, Montserrat; Solanes, Núria; Fernandez-Armenta, Juan; Silva, Etelvino; Doltra, Adelina; Duchateau, Nicolas; Barcelo, Aina; Gabrielli, Luigi; Bijnens, Bart; Berruezo, Antonio; Brugada, Josep; Sitges, Marta

    2013-08-01

    Animal models that mimic human electrical and mechanical dyssynchrony often associated with chronic heart failure would provide an essential tool to investigate factors influencing response to cardiac resynchronization therapy. A standardized closed-chest porcine model of left bundle branch block (LBBB) was developed using 16 pigs. Radiofrequency applications were performed to induce LBBB, which was confirmed by QRS widening, a surface electrocardiogram pattern concordant with LBBB, and a prolonged activation time from endocardial. Echocardiography confirmed abnormal motion of the septum, which was not present at the baseline echocardiogram. High susceptibility of pigs to ventricular fibrillation during the endocardial ablation was overcome by applying high-rate pacing during radiofrequency applications. This is the first study to devise a closed-chest porcine model of LBBB that closely reproduces abnormalities found in patients with electrical and mechanical cardiac dyssynchrony, and provides a useful tool to investigate the basic mechanisms underlying cardiac resynchronization therapy benefits in heart failure.

  9. Exercise-induced left bundle branch block and subsequent mechanical left ventricular dyssynchrony -resolved with pharmacological therapy

    Science.gov (United States)

    2011-01-01

    A 53-year-old man with depressed ejection fraction (EF) of 35% and QRS width of 88 ms at rest was admitted to our institution with a complaint of exertional chest discomfort and dyspnea. During treadmill exercise, left bundle-branch block (LBBB) with a QRS width of 152 ms occurred at a heart rate of 100 bpm. During LBBB, the patient showed significant mechanical dyssynchrony as evidenced by a two-dimensional speckle tracking radial strain of 260 ms (≥130 ms), defined as the time difference between anterior-septum and posterior wall. Five-month after carvedilol and candesartan administration, EF had improved to 49% and LBBB did not occur until a heart rate of 126 bpm was attained during treadmill exercise. It appears that pharmacological therapy may be useful for patients with heart failure and exercise-induced LBBB. PMID:21294925

  10. Exercise-induced left bundle branch block and subsequent mechanical left ventricular dyssynchrony -resolved with pharmacological therapy

    Directory of Open Access Journals (Sweden)

    Tatsumi Kazuhiro

    2011-02-01

    Full Text Available Abstract A 53-year-old man with depressed ejection fraction (EF of 35% and QRS width of 88 ms at rest was admitted to our institution with a complaint of exertional chest discomfort and dyspnea. During treadmill exercise, left bundle-branch block (LBBB with a QRS width of 152 ms occurred at a heart rate of 100 bpm. During LBBB, the patient showed significant mechanical dyssynchrony as evidenced by a two-dimensional speckle tracking radial strain of 260 ms (≥130 ms, defined as the time difference between anterior-septum and posterior wall. Five-month after carvedilol and candesartan administration, EF had improved to 49% and LBBB did not occur until a heart rate of 126 bpm was attained during treadmill exercise. It appears that pharmacological therapy may be useful for patients with heart failure and exercise-induced LBBB.

  11. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    Science.gov (United States)

    Dou, Jianhong; Xia, Ling; Zhang, Yu; Shou, Guofa; Wei, Qing; Liu, Feng; Crozier, Stuart

    2009-01-01

    Asynchronous electrical activation, induced by bundle branch block (BBB), can cause reduced ventricular function. However, the effects of BBB on the mechanical function of heart are difficult to assess experimentally. Many heart models have been developed to investigate cardiac properties during BBB but have mainly focused on the electrophysiological properties. To date, the mechanical function of BBB has not been well investigated. Based on a three-dimensional electromechanical canine heart model, the mechanical properties of complete left and right bundle branch block (LBBB and RBBB) were simulated. The anatomical model as well as the fiber orientations of a dog heart was reconstructed from magnetic resonance imaging (MRI) and diffusion tensor MRI (DT-MRI). Using the solutions of reaction-diffusion equations and with a strategy of parallel computation, the asynchronous excitation propagation and intraventricular conduction in BBB was simulated. The mechanics of myocardial tissues were computed with time-, sarcomere length-dependent uniaxial active stress initiated at the time of depolarization. The quantification of mechanical intra- and interventricular asynchrony of BBB was then investigated using the finite-element method with an eight-node isoparametric element. The simulation results show that (1) there exists inter- and intraventricular systolic dyssynchrony during BBB; (2) RBBB may have more mechanical synchrony and better systolic function of the left ventricle (LV) than LBBB; (3) the ventricles always move toward the early-activated ventricle; and (4) the septum experiences higher stress than left and right ventricular free walls in BBB. The simulation results validate clinical and experimental recordings of heart deformation and provide regional quantitative estimates of ventricular wall strain and stress. The present work suggests that an electromechanical heart model, incorporating real geometry and fiber orientations, may be helpful for better

  12. Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction.

    Science.gov (United States)

    Sørensen, Jacob Thorsted; Stengaard, Carsten; Sørensen, Christina Ankjær; Thygesen, Kristian; Bøtker, Hans Erik; Thuesen, Leif; Terkelsen, Christian Juhl

    2013-06-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan-Meier plots and compared using log-rank statistics. AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome.

  13. Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction

    Science.gov (United States)

    Stengaard, Carsten; Sørensen, Christina Ankjær; Thygesen, Kristian; Bøtker, Hans Erik; Thuesen, Leif; Terkelsen, Christian Juhl

    2013-01-01

    Background: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. Methods: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan–Meier plots and compared using log-rank statistics. Results: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. Conclusions: Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome. PMID:24222828

  14. Comparative Long-Term Outcomes after Cardiac Resynchronization Therapy in Right Ventricular Paced Patients versus Native Wide Left Bundle Branch Block Patients

    DEFF Research Database (Denmark)

    Tayal, Bhupendar; Gorcsan, John; Delgado-Montero, Antonia

    2016-01-01

    to compare the long-term survival after CRT in patients upgraded from RVP with that in patients with left bundle branch block (LBBB) with QRS duration ≥ 150 ms and to compare the mechanical properties associated with CRT response in these groups. METHODS: Overall, 135 patients with implanted CRT from...

  15. Identification of Typical Left Bundle Branch Block Contraction by Strain Echocardiography Is Additive to Electrocardiography in Prediction of Long-Term Outcome After Cardiac Resynchronization Therapy

    DEFF Research Database (Denmark)

    Risum, Niels; Tayal, Bhupendar; Hansen, Thomas F

    2015-01-01

    BACKGROUND: Current guidelines suggest that patients with left bundle branch block (LBBB) be treated with cardiac resynchronization therapy (CRT); however, one-third do not have a significant activation delay, which can result in nonresponse. By identifying characteristic opposing wall contractio...

  16. Utility of incomplete right bundle branch block as an isolated ECG finding in children undergoing initial cardiac evaluation.

    Science.gov (United States)

    Meziab, Omar; Abrams, Dominic J; Alexander, Mark E; Bevilacqua, Laura; Bezzerides, Vassilios; Mah, Doug Y; Walsh, Edward P; Triedman, John K

    2018-02-12

    This study evaluates the ability of experienced pediatric electrophysiologists (EPs) to reliably classify incomplete right bundle branch block (IRBBB) and assesses its clinical utility as an isolated ECG finding in a group of healthy outpatient children without prior cardiac evaluation. We performed a retrospective analysis of all electrocardiographic and echocardiographic records at Boston Children's Hospital between January 1, 2005, and December 31, 2014. Echocardiographic diagnoses were identified if registered between the date of the index electrocardiogram and the ensuing year. A selected subset of 473 ECGs was subsequently reanalyzed in a blinded manner by six pediatric EPs to determine the consistency with which the finding of IRBBB could be assigned. Of the 331 278 ECGs registered in the BCH database, 32 127 (9.7%) met inclusion criteria and were analyzed for the prevalence of isolated right bundle conduction disturbance findings. The mean age was 12.1 ± 4.0 years, and the population was 49% male. Of the 32 127 ECGs, 72.5% were coded normal, 3.0% were coded IRBBB, and 0.5% were coded complete right bundle branch block (CRBBB). A total of 7.3% of patients coded as normal had an ensuing echocardiogram, compared to 12.5% coded IRBBB. Echo findings were recorded in 0.1% of normal and 0.2% of IRBBB. Patients with ASD-secundum type were no more likely to have isolated IRBBB on previous ECG than the general population (2.5% vs 3.0%). Analysis of inter-reader variability in ECG findings and conduction disturbance identification was high (range of IRBBB prevalence 1-20% among readers). Reinterpretation of ECGs using explicit diagnostic criteria did not demonstrate consistent discrimination of IRBBB and Normal ECGs. IRBBB is not uncommon in a healthy school age population and is observed to have high inter-reader variability. It was associated with increased use of echocardiographic exam but was not associated with increased rate of echocardiographic findings

  17. Right ventricular electrical and mechanical synchronization by properly timed septal pacing in a patient with right bundle branch block and first degree AV block--a case report.

    Science.gov (United States)

    Siliste, Calin; Suran, Maria-Claudia-Berenice; Margulescu, Andrei-Dumitru; Vinereanu, Dragos

    2015-03-01

    We present a case of near-normalization of the QRS by septal pacing in a patient with dual-chamber pacemaker and underlying complete right bundle branch block and first degree atrioventricular block. The right ventricular mechanical synchronization suggested by the ECG was validated as such by strain echo. To the best of our knowledge, this is the first time it has been shown that the narrowing of the QRS corresponds to mechanical synchronization in a case of this seldom-recognized phenomenon. © 2014 Wiley Periodicals, Inc.

  18. Right bundle branch block and middle septal fiber block with or without left anterior fascicular block manifested as aberrant conduction in apparent healthy individuals: Electro-vectorcardiographic characterization.

    Science.gov (United States)

    Acunzo, Rafael S; Konopka, Isabel V; Sanchéz, Rubén A; Pizzarelli, Norma; Wells, Fernanda Comas; Baranchuk, Adrian; Chiale, Pablo A

    2013-01-01

    Right bundle branch block (RBBB) evident in the precordial ECG leads may be associated with evidence of left bundle branch involvement in the limb leads. Any of the components of the left bundle can be involved, and this complex interventricular conduction abnormality has previously been described in patients with underlying heart disease. To analyze the electro-vectorcardiographic manifestations of RBBB with left middle septal fiber block (LMSFB), with or without left anterior fascicular block (LAFB) in premature atrial beats of patients without apparent structural heart disease. Twelve patients (8 men/4 women; mean age: 32±8years) with premature atrial contractions with this conduction abnormality were included. Surface 12 simultaneous lead ECG recordings and the corresponding vectorcardiographic loops were analyzed. The QRS complexes with RBBB and also LMSFB persisted for between 150 and 190ms. There were no q waves in lead I. The maximum spatial vector (72-86ms) was directed posteriorly, superiorly, and leftward, and the terminal forces were oriented anteriorly, inferiorly and rightward. In 10 patients, small q waves were apparent in leads V1-V2 and the frontal QRS axis was -60° and -70°, with the 46ms vector located at -50°±5. All of these patients most probably had LAFB in addition to LMSFB. In two patients, the initial electrical forces were directed anteriorly, inferiorly, and leftward, and the 46ms vector axis in the frontal plane was 6° and 11°, respectively, indicating absence of LAFB. The combination of RBBB and LMSFB occurring in patients without apparent structural heart disease may be related to the simultaneous occurrence of block of conduction through these components of the Purkinje network. The anterior fascicle of the left bundle may also be involved. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Mortality risk associated with bundle branch blocks and related repolarization abnormalities (from the Women's Health Initiative [WHI]).

    Science.gov (United States)

    Zhang, Zhu-ming; Rautaharju, Pentti M; Soliman, Elsayed Z; Manson, Joann E; Cain, Michael E; Martin, Lisa W; Bavry, Anthony A; Mehta, Laxmi; Vitolins, Mara; Prineas, Ronald J

    2012-11-15

    Electrocardiographic bundle branch block (BBB) has higher cardiac and all-cause death. However, reports on the association between BBBs and mortality in the general populations are conflicting. The aim of this study was to evaluate the risk for coronary heart disease (CHD) and all-cause death associated with left BBB (LBBB) and right BBB (RBBB) during 14 years of follow-up in 66,450 participants from the Women's Health Initiative (WHI) study. Cox proportional-hazards regression was performed for mortality risk in Women with LBBB (n = 714) and those with RBBB (n = 832). In risk models adjusted for demographic and clinical risk factors in women with cardiovascular disease (CVD), hazard ratios for CHD death were 2.92 (95% confidence interval 2.08 to 4.08, p women, only LBBB was a significant predictor of CHD death (fully adjusted hazard ratio 2.17, 95% confidence interval 1.37 to 3.43, p women with LBBB was an independent predictor of CHD death, with a more than fivefold increase in risk. None of the repolarization variables were independent predictors in women with RBBB. In conclusion, prevalent LBBB in CVD-free women and LBBB and RBBB in women with CVD were significant predictors of CHD death. In women with LBBB, ST J-point depression in lead aVL was a strong independent predictor of CHD death. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Reservations about the Selvester QRS score in left bundle branch block - Experience in patients with transcatheter aortic valve implantation.

    Science.gov (United States)

    Poels, Thomas T; Kats, Suzanne; Veenstra, Leo; van Ommen, Vincent; Maessen, Jos G; Prinzen, Frits W

    The Selvester QRS score (S-score) estimates myocardial scar using electrocardiographic criteria. We evaluated the S-score for left bundle branch block (LBBB). Studied were 36 patients who developed persistent LBBB upon transcatheter aortic valve implantation (TAVI, TAVI-LBBB group) and 36 matched patients with persistent narrow QRS (TAVI-nQRS group). Electrocardiograms were recorded before and briefly after TAVI and during ~6months follow-up. S-score was calculated using criteria for hypertrophic (in absence of LBBB) or LBBB hearts. In TAVI-LBBB patients correlation between S-scores pre-TAVI and post-TAVI was absent (R 2 =0.023). High S-scores post-TAVI occurred in patients with low pre-TAVI scores. Pre-post TAVI scores correlated weakly in TAVI-nQRS (R 2 =0.182), indicating a possible influence of ventricular unloading by TAVI. In both groups S-scores at post-TAVI and follow-up compared reasonably (R 2 =0.389 and R 2 =0.386), indicating reproducibility in more stable conditions. This study indicates that the use of the LBBB S-score criteria overestimates scar size and that caution is recommended in the use of the score in patients with LBBB. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  1. Clinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on Presentation.

    Science.gov (United States)

    Chan, William K; Goodman, Shaun G; Brieger, David; Fox, Keith A A; Gale, Chris P; Chew, Derek P; Udell, Jacob A; Lopez-Sendon, Jose; Huynh, Thao; Yan, Raymond T; Singh, Sheldon M; Yan, Andrew T

    2016-03-01

    We examined the relations between right bundle branch block (RBBB) and clinical characteristics, management, and outcomes among a broad spectrum of patients with acute coronary syndrome (ACS). Admission electrocardiograms of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) electrocardiogram substudy and the Canadian ACS Registry I were analyzed independently at a blinded core laboratory. We performed multivariable logistic regression analysis to assess the independent prognostic significance of admission RBBB on in-hospital and 6-month mortality. Of 11,830 eligible patients with ACS (mean age 65; 66% non-ST-elevation ACS), 5% had RBBB. RBBB on admission was associated with older age, male sex, more cardiovascular risk factors, worse Killip class, and higher GRACE risk score (all p 0.50). In conclusion, across a spectrum of ACS, RBBB was associated with preexisting cardiovascular disease, high-risk clinical features, fewer cardiac interventions, and worse unadjusted outcomes. After adjusting for components of the GRACE risk score, RBBB was a significant independent predictor of early mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Prognostic Implication of the QRS Axis and its Association with Myocardial Scarring in Patients with Left Bundle Branch Block.

    Science.gov (United States)

    Park, Chan Soon; Cha, Myung-Jin; Choi, Eue-Keun; Oh, Seil

    2017-03-01

    Left bundle branch block (LBBB) with left axis deviation (LAD) has a worse prognosis than LBBB with a normal axis, and myocardial dysfunction has been suggested as a cause of left axis deviation. This study investigated the prognostic significance of the QRS axis in patients with LBBB and analyzed its relationship with the amount of myocardial scarring. A total of 829 patients were diagnosed with LBBB at Seoul National University Hospital from October 2004 to June 2014. Of these, 314 who were asymptomatic and had no previous history of cardiac disease were included in the present study. Myocardial scarring was calculated using the Selvester QRS scoring system, and LAD was defined as a QRS axis between -180° and -30°. Of the total patients, 91 (29%) had LAD, and patients were followed for a median of 30 months. During follow-up, two patients were hospitalized for de novo heart failure, four had pacemaker implants, and 10 died. There was a significant inverse correlation between myocardial scar score and the QRS axis (r=-0.356, paxis (5.5% vs. 1.3%, log-rank p=0.010); the prognostic value was attenuated in multivariable analysis (hazard ratio 4.117; 95% confidence interval 0.955-17.743; p=0.058). Concomitant LAD is an indicator of poor prognosis for patients with LBBB and may be associated with greater myocardial scarring.

  3. Left bundle branch block with intermittent QRS axis switching: observation of a hypertensive patient for 18 years.

    Science.gov (United States)

    Takato, Tetsuya; Yamada, Namie; Fujii, Jun; Mashima, Saburo; Ashida, Terunao

    2009-09-01

    A 64-year-old man who had been prescribed antihypertensive drugs since 1971 attended our clinic in 1988 with hypertension and electrocardiographic abnormalities. An electrocardiogram revealed left axis deviation (LAD) in 1988 and slightly prolonged PQ intervals in 1993. Complete left bundle branch block (CLBBB) with LAD developed in May 1995. The wide QRS of the CLBBB had never returned to the normal narrow QRS and had intermittently alternated between LAD and normal axis. The PQ intervals were longer when the QRS axis showed LAD compared to that with normal QRS axis. The QRS complexes in leads V1-V3 revealed an R wave at LAD and a QS pattern at normal axis. During a deep breathing test, the QRS axis switched from normal axis to LAD at the end of forced expiration and also switched from normal axis to LAD within a few minutes after the exercise test. These results suggest that the shift of the QRS axis might be related to the tone of the autonomic nervous system.

  4. Atrial fibrillation with left bundle branch block and intermittent right axis deviation during acute myocardial infarction.

    Science.gov (United States)

    Patanè, Salvatore; Marte, Filippo; Di Bella, Gianluca

    2008-06-23

    Rarely the ECG shows an LBBB with changing QRS morphology and changing axis deviation. The intermittent positive aspect of the neglected lead aVR indicates an intermittent right axis deviation in the presence of complete LBBB. An additional left posterior fascicular block accompanying predivisional LBBB is the possible explanation. We describe the case of a 78-year-old Italian woman admitted to the Cardiology Unit with acute myocardial infarction and permanent atrial fibrillation. Electrocardiographic changes were observed. The ECG showed atrial fibrillation and LBBB with intermittent left axis deviation or atrial fibrillation and LBBB with intermittent right axis deviation.

  5. Comparison of incidence and predictors of left bundle branch block after transcatheter aortic valve implantation using the CoreValve versus the Edwards valve.

    Science.gov (United States)

    Franzoni, Irene; Latib, Azeem; Maisano, Francesco; Costopoulos, Charis; Testa, Luca; Figini, Filippo; Giannini, Francesco; Basavarajaiah, Sandeep; Mussardo, Marco; Slavich, Massimo; Taramasso, Maurizio; Cioni, Micaela; Longoni, Matteo; Ferrarello, Santo; Radinovic, Andrea; Sala, Simone; Ajello, Silvia; Sticchi, Alessandro; Giglio, Manuela; Agricola, Eustachio; Chieffo, Alaide; Montorfano, Matteo; Alfieri, Ottavio; Colombo, Antonio

    2013-08-15

    Conduction disorders and permanent pacemaker implantation are common complications in patients who undergo transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the incidence and clinical significance of new bundle branch block in patients who underwent TAVI with the Medtronic CoreValve Revalving System (MCRS) or the Edwards SAPIEN valve (ESV). Data from 238 patients with no previous pacemaker implantation, left bundle branch block (LBBB) or right bundle branch block at baseline electrocardiography who underwent TAVI with either MCRS (n = 87) or ESV (n = 151) bioprostheses from 2007 to 2011 were analyzed. New-onset LBBB occurred in 26.5% patients (n = 63): 13.5% with the ESV (n = 20) and 50.0% with the MCRS (n = 43) (p = 0.001). Permanent pacemaker implantation was required in 12.7% of patients (n = 8) because of complete atrioventricular block (ESV n = 2, MCRS n = 4), LBBB and first degree atrioventricular block (MCRS n = 1) and new-onset LBBB associated with sinus bradycardia (MCRS n = 1). At discharge, LBBB persisted in 8.6% of ESV patients (n = 13) and 32.2% of MCRS patients (n = 28) (p = 0.001). On multivariate analysis, the only predictor of LBBB was MCRS use (odds ratio 7.2, 95% confidence interval 2.9 to 17.4, p bundle branch block was documented in 4.6% of patients (n = 11), with no statistically significant differences between the ESV and MCRS. In conclusion, new-onset LBBB is a frequent intraventricular conduction disturbance after TAVI with a higher incidence with the MCRS compared with the ESV. LBBB persists in most patients, but in this cohort, it was not a predictor of overall or cardiovascular mortality or permanent pacemaker implantation. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Predictive factor and clinical consequence of left bundle-branch block after a transcatheter aortic valve implantation.

    Science.gov (United States)

    Nishiyama, Takahiko; Tanosaki, Sho; Tanaka, Makoto; Yanagisawa, Ryo; Yashima, Fumiaki; Kimura, Takehiro; Arai, Takahide; Tsuruta, Hikaru; Murata, Mitsushige; Aizawa, Yoshiyasu; Kohno, Takashi; Maekawa, Yuichiro; Hayashida, Kentaro; Takatsuki, Seiji; Fukuda, Keiichi

    2017-01-15

    Atrioventricular conduction disturbances can develop after transcatherter aortic valve implantations (TAVIs) with balloon-expandable valves because the conduction system exists adjacent to the aortic valve. However, the clinical consequence of patients with new onset conduction disturbances is not clear. This study aimed to assess the incidence and progress of new-onset conduction disturbances following TAVIs and the cardiac function evaluated by echocardiography. This study consisted of 90 consecutive patients that underwent TAVIs with Edwards SAPIEN XT valves in a single center. Atrioventricular conduction system disturbances were assessed by electrocardiography and echocardiography up to 6months post TAVI. Twenty patients (22%) developed new onset complete left bundle branch block (CLBBB) or received pacemaker implantations (PMIs) during the follow-up. At 6months after the procedure, 4 patients underwent PMIs for complete AV block (CAVB), and 4 patients had persistent CLBBB. Those that developed CLBBB and AVB had a higher morbidity from hypertension and lower estimated glomerular filtration rate (eGFR). The ECG, TTE, and CT parameters did not differ between the two groups. The ratio of the valve and LVOT area was significantly associated with a higher cumulative risk of events (HR, 3.005; 95% CI, 1.034-8.736; P<0.05). Up to 20% of patients developed new CLBBB or CAVB and more than half were expected to recover. However, it required attention because approximately 40% were persistent. The ratio of the valve to LVOT area was an independent predictor. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Atrial septal aneurysm associated with additional cardiovascular comorbidities in two middle age female patients with ECG signs of right bundle branch block: two case reports.

    Science.gov (United States)

    Bakalli, Aurora; Kamberi, Lulzim; Pllana, Ejup; Gashi, Afrim

    2008-07-19

    Atrial septal aneurysm (ASA) is often associated with other atrial septal abnormalities, particularly with atrial septal defect type ostium secundum or patent foramen ovale. ECG signs of incomplete or complete right bundle branch block are known to be associated with atrial septal defects, however such correlation with other atrial septal abnormalities is not documented. We report here two cases of middle age female patients that presented with dyspnea on physical effort, right bundle branch block (RBBB) on ECG and ASA combined with other cardiac disorders. Transesophageal echocardiography revealed additional information to the ones obtained by surface echocardiography, in both cases. ASA associated with RBBB on ECG may serve as a hint for the presence of additional cardiac abnormalities, thus rousing the demand for a detailed cardiac investigation.

  8. Applicability of a Novel Formula (Bogossian formula) for Evaluation of the QT-Interval in Heart Failure and Left Bundle Branch Block Due to Right Ventricular Pacing.

    Science.gov (United States)

    Frommeyer, Gerrit; Bogossian, Harilaos; Pechlivanidou, Eleni; Conzen, Philipp; Gemein, Christopher; Weipert, Kay; Helmig, Inga; Chasan, Ritvan; Johnson, Victoria; Eckardt, Lars; Hamm, Christian W; Seyfarth, Melchior; Lemke, Bernd; Zarse, Markus; Schmitt, Jörn; Erkapic, Damir

    2017-04-01

    The presence of left bundle branch block (LBBB) due to right ventricular pacing represents a particular challenge in properly measuring the QTc interval. In 2014, a new formula for the evaluation of QT interval in patients with LBBB was reported. 145 patients with implantable cardioverter defibrillator were included in this prospective multicenter observational study. Inclusion criteria were: no permanent right ventricular stimulation, an intrinsic QRS interval of QT-interval must be respected. © 2017 Wiley Periodicals, Inc.

  9. Mechanical dispersion is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks.

    Science.gov (United States)

    Stankovic, Ivan; Janicijevic, Aleksandra; Dimic, Aleksandra; Stefanovic, Milica; Vidakovic, Radosav; Putnikovic, Biljana; Neskovic, Aleksandar N

    2018-03-01

    Bundle branch blocks (BBB)-related mechanical dyssynchrony and dispersion may improve patient selection for device therapy, but their effect on the natural history of this patient population is unknown. A total of 155 patients with LVEF ≤ 35% and BBB, not treated with device therapy, were included. Mechanical dyssynchrony was defined as the presence of either septal flash or apical rocking. Contraction duration was assessed as time interval from the electrocardiographic R-(Q-)wave to peak longitudinal strain in each of 17 left ventricular segments. Mechanical dispersion was defined as either the standard deviation of all time intervals (dispersion SD ) or as the difference between the longest and shortest time intervals (dispersion delta ). Patients were followed for cardiac mortality during a median period of 33 months. Mechanical dyssynchrony was not associated with survival. More pronounced mechanical dispersion delta was found in patients with dyssynchrony than in those without. In the multivariate regression analysis, patients' functional class, diabetes mellitus and dispersion delta were independently associated with mortality. Mechanical dispersion, but not dyssynchrony, was independently associated with mortality and it may be useful for risk stratification of patients with heart failure (HF) and BBB. Key Messages Mechanical dispersion, measured by strain echocardiography, is associated with poor outcome in heart failure with a severely depressed left ventricular function and bundle branch blocks. Mechanical dispersion may be useful for risk stratification of patients with heart failure and bundle branch blocks.

  10. Sex Differences in Long-Term Outcomes With Cardiac Resynchronization Therapy in Mild Heart Failure Patients With Left Bundle Branch Block.

    Science.gov (United States)

    Biton, Yitschak; Zareba, Wojciech; Goldenberg, Ilan; Klein, Helmut; McNitt, Scott; Polonsky, Bronislava; Moss, Arthur J; Kutyifa, Valentina

    2015-06-29

    Previous studies have shown conflicting results regarding the benefit of cardiac resynchronization therapy (CRT) by sex and QRS duration. In the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated long-term clinical outcome of heart failure (HF) or death, death, and HF alone by sex and QRS duration (dichotomized at 150 ms) in left bundle-branch block patients with CRT with defibrillator backup (CRT-D) versus implantable cardioverter-defibrillator (ICD) only. There were 394 women (31%) and 887 men with left bundle-branch block. During the median follow-up of 5.6 years, women derived greater clinical benefit from CRT-D compared with implantable cardioverter-defibrillator only, with a significant 71% reduction in HF or death (hazard ratio [HR] 0.29, P150 ms. During long-term follow-up of mild HF patients with left ventricular dysfunction and wide QRS, both women and men with left bundle-branch block derived sustained benefit from CRT-D versus implantable cardioverter-defibrillator only, with significant reduction in HF or death, HF alone, and all-cause mortality regardless of QRS duration. There is an incremental benefit with CRT-D in women for the end points of HF or death and HF alone. URL: https://clinicaltrials.gov/. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  11. Left bundle-branch block contraction patterns identified from radial-strain analysis predicts outcomes following cardiac resynchronization therapy.

    Science.gov (United States)

    Wang, Chun-Li; Wu, Chia-Tung; Yeh, Yung-Hsin; Wu, Lung-Sheng; Chan, Yi-Hsin; Kuo, Chi-Tai; Chu, Pao-Hsien; Hsu, Lung-An; Ho, Wan-Jing

    2017-06-01

    A left bundle-branch block (LBBB) contraction pattern identified from longitudinal-strain analysis predicts outcomes following cardiac resynchronization therapy (CRT). We investigated the use of an LBBB-contraction pattern identified from radial- or circumferential-strain analysis in the prediction of CRT benefits. Eighty CRT candidates were prospectively enrolled. Before CRT implantation, speckle-tracking analyses in three deformation directions were performed to determine whether an LBBB-contraction pattern was present. The study endpoints were reverse remodeling at 6 months, and adverse outcomes including death or heart failure hospitalization. At 6 months, 49 (61%) patients had reverse remodeling. An LBBB-contraction pattern identified from the radial strain in the mid-ventricular short-axis view or longitudinal strain in the four-chamber view provided excellent true-positive (86%) and false-negative (8%) rates for predicting reverse remodeling. During a median follow-up of 30 months, 31 patients (39%) had adverse outcomes. Absence of an LBBB-contraction pattern in radial (hazard ratio 3.74; 95% confidence interval 1.83-7.62) or longitudinal strain (hazard ratio 3.49; 95% confidence interval 1.71-7.13) was significantly associated with an increased risk of adverse outcomes. Adding the LBBB-pattern assessment by radial-(model χ 2 from 8.2 to 18.5, p = 0.005), or longitudinal-strain analysis (model χ 2 from 8.2 to 16.9, p = 0.011) to a risk model significantly improved the model, including QRS duration and ischemic etiology. In conclusion, an LBBB-contraction pattern identified from radial-strain analysis in the mid-ventricular short-axis view predicted reverse remodeling and outcome following CRT, similarly to the longitudinal-strain analysis.

  12. Differentiating the QRS Morphology of Posterior Fascicular Ventricular Tachycardia From Right Bundle Branch Block and Left Anterior Hemiblock Aberrancy.

    Science.gov (United States)

    Michowitz, Yoav; Tovia-Brodie, Oholi; Heusler, Ishai; Sabbag, Avi; Rahkovich, Michael; Shmueli, Hezzy; Glick, Aharon; Belhassen, Bernard

    2017-09-01

    Left posterior fascicular ventricular tachycardia (LPF-VT) is frequently misdiagnosed as supraventricular tachycardia with aberrant right bundle branch block (RBBB) and left anterior hemiblock (LAHB). The purpose of the present study was to define the morphological ECG characteristics of LPF-VT and attempt to differentiate it from RBBB and LAHB aberrancy. A systematic Medline search was used to identify or locate ECG tracings from patients with LPF-VTs. ECGs with LPF-VT were also collected from patients who underwent ablation of this arrhythmia at the Tel Aviv and Sheba Medical Centers. These ECGs were compared with ECGs of consecutive patients with RBBB and LAHB and no obvious cardiac pathology by echocardiography. Overall, 183 ECGs of LPF-VT were compared with 61 ECGs showing RBBB and LAHB. Univariate analysis demonstrated differences in QRS axis, limb (I, aVr), and precordial (V 1 , V 2 , V 6 ) ECG leads. On multivariate logistic regression analysis, LPF-VT was more often associated with atypical RBBB-like V 1 morphology (odds ratio, 5.1; P =0.004), positive QRS in aVr (odds ratio, 19.2; P <0.001), V 6 R/S ratio ≤1 (odds ratio, 6.7; P =0.01), and QRS ≤140 ms (odds ratio, 7.7; P <0.001). Using these 4 variables, a prediction model was developed that predicted LPF-VT with sensitivity and specificity of 82.1% and 78.3%, respectively. Patients with 3 of 4 positive variables had high probability of having LPF-VT, whereas patients with ≤1 positive variable always had RBBB plus LAHB. The morphological ECG characteristics of LPF-VT were defined, and a high accurate tool for correctly differentiating LPF-VT from RBBB and LAHB aberrancy was developed. © 2017 American Heart Association, Inc.

  13. Comparison of the Electrocardiographic Features of Complete Left Bundle Branch Block in Patients with Ischemic and Nonischemic Left Ventricular Dysfunction

    Directory of Open Access Journals (Sweden)

    Tumer Erdem Guler

    2007-01-01

    Full Text Available Background: Differentiating ischemic (ILVD from nonischemic left ventricular dysfunction (NILVD is important prognostically and therapeutically but might be difficult clinically. The differentiating role of electrocardiographic (ECG features in the presence of left bundle-branch block (LBBB is debatable on differentiating ILVD from NILVD.Objective: The present study assessed whether there is the role of certain ECG features in differentiating ILVD from NILVD in the presence of the complete LBBB.Methods and Results: Patients who had LBBB were divided into two groups based on the presence and type of left ventricular dysfunction; (1 ILVD group (49 patients; 20 female; age: 65 ± 11 years and (2 NILVD group (49 patients; 22 female; age: 59 ± 12 years, and numerous ECG features were compared. Most of these ECG features did not show any difference between the groups except for following ECG findings; the voltage of R wave in V6 were statistically higher in NILVD group compared ILVD group (p: 0.03; the depression of the ST-J point by more than 0.2 mV in V6 were also frequently observed in NILVD group compared ILVD group (5/ 10% vs 19/ 39% , p: 0.001; and the notching in the ascending or descending limb of the S wave in V1-4 leads were more in ILVD group (18/ 36% vs 8/ 16% p: 0.03; 9/ 16% vs 2/ 4%, p: 0.03, respectively.Conclusions: In the current study, although some ECG findings were found to be useful, ECG features in the presence of complete LBBB had poor value in differentiating ILVD from NILVD.

  14. Early Changes in QRS Frequency Following Cardiac Resynchronization Predict Hemodynamic Response in Left Bundle Branch Block Patients.

    Science.gov (United States)

    Niebauer, Mark J; Rickard, John; Tchou, Patrick J; Varma, Niraj

    2016-05-01

    QRS characteristics are the cornerstone of patient selection in cardiac resynchronization therapy (CRT) and the presence of left bundle branch block (LBBB) and baseline QRS ≥150 milliseconds portends a good outcome. We previously showed that baseline QRS frequency analysis adds predictive value to LBBB alone and have hypothesized that a change in frequency characteristics following CRT may produce additional predictive value. We examined the QRS frequency characteristics of 182 LBBB patients before and soon after CRT. Patients were assigned to responder and nonresponder groups. Responders were defined by a decrease in left ventricular end-systolic volume (LVESV) ≥15% following CRT. We analyzed the QRS in ECG leads I, AVF, and V3 before and soon after CRT using the discrete Fourier transform algorithm. The percentage of total QRS power within discrete frequency intervals before and after CRT was calculated. The reduction in lead V3 power <10 Hz was the best indicator of response. Baseline QRS width was similar between the responders and nonresponders (162.2 ± 17.2 milliseconds vs. 158 ± 22.1 milliseconds, respectively; P = 0.180). Responders exhibited a greater reduction in QRS power <10 Hz (-17.0 ± 11.9% vs. -6.6 ± 12.5%; P < 0.001) and a significant AUC (0.743; P < 0.001). A ≥8% decline in QRS power <10 Hz produced the best predictive values (PPV = 84%, NPV = 59%). Importantly, when patients with baseline QRS <150 milliseconds were compared, the AUC improved (0.892, P < 0.001). Successful CRT produces a significant reduction in QRS power below 10 Hz, particularly when baseline QRS <150 milliseconds. These results indicate that QRS frequency changes after CRT provide additional predictive value to QRS alone. © 2016 Wiley Periodicals, Inc.

  15. T-wave area predicts response to cardiac resynchronization therapy in patients with left bundle branch block.

    Science.gov (United States)

    Engels, Elien B; Végh, Eszter M; Van Deursen, Caroline J M; Vernooy, Kevin; Singh, Jagmeet P; Prinzen, Frits W

    2015-02-01

    Chronic heart failure patients with a left ventricular (LV) conduction delay, mostly due to left bundle branch block (LBBB), generally derive benefit from cardiac resynchronization therapy (CRT). However, 30-50% of patients do not show a clear response to CRT. We investigated whether T-wave analysis of the ECG can improve patient selection. The study population comprised 244 CRT recipients with baseline 12-lead electrocardiogram recordings. Echocardiographic response after 6-month CRT was defined as a ≥5% increase in LV ejection fraction (LVEF). Vectorcardiograms (VCGs) were constructed from the measured 12-lead ECGs using an adapted Kors algorithm on digitized ECGs. Logistic regression models indicated repolarization variables as good predictors of CRT response. The VCG-derived T-wave area predicted CRT response (odds ratio [OR] per 10 μVs increase 1.172 [P < 0.001]) even better than QRS-wave area (OR = 1.116 [P = 0.001]). T-wave area had especially predictive value in the LBBB patient group (OR = 2.77 in LBBB vs. 1.09 in non-LBBB). This predictive value persisted after adjustment of multiple covariates, such as gender, ischemia, age, hypertension, coronary artery bypass graft, and the usage of diuretics and β-blockers. In LBBB patients, the increase in LVEF was 6.1 ± 9.7% and 11.3 ± 9.1% in patients with T-wave area below and above the median value, respectively (P < 0.01). In patients with LBBB morphology of the QRS complex, a larger baseline T-wave area is an important independent predictor of LVEF increase following CRT. © 2014 Wiley Periodicals, Inc.

  16. Association of left bundle branch block with obstructive coronary artery disease on coronary CT angiography: a case-control study.

    Science.gov (United States)

    Clerc, Olivier F; Possner, Mathias; Maire, René; Liga, Riccardo; Fuchs, Tobias A; Stehli, Julia; Vontobel, Jan; Mikulicic, Fran; Gräni, Christoph; Benz, Dominik C; Lüscher, Thomas F; Herzog, Bernhard A; Buechel, Ronny R; Kaufmann, Philipp A; Gaemperli, Oliver

    2016-07-01

    Left bundle branch block (LBBB) is considered an unfavourable prognostic marker in patients with underlying heart disease. Testing for coronary artery disease (CAD) is often prompted by incidental LBBB finding, but published studies disagree about a significant association between LBBB and CAD. We therefore assessed the association of LBBB with previously unknown CAD in patients undergoing coronary computed tomography angiography (CCTA). We enrolled 818 patients (mean age 57.2 ± 11.1 years, 106 patients with presumably new LBBB and 712 controls) without known CAD who underwent 64-slice CCTA. Image quality was assessed for each coronary segment. Comparison of obstructive CAD prevalence (defined as ≥50% stenosis) was performed using triple case-matching for pre-test probability (based on age, gender, and symptom typicality) in 101 LBBB patients and 303 matched controls with diagnostic quality in all segments. We found no difference in obstructive CAD prevalence between LBBB patients and matched controls (15 vs. 16%, P = 0.88). Similarly, there were no significant differences in cardiovascular risk factors (CVRF), stenosis severity, CAD extent, non-obstructive CAD, and vessel-based analysis between patient groups. Image quality was very high in LBBB patients and comparable to controls. On multivariate analysis, age, gender, typical angina, and CVRF, but not LBBB (P = 0.94), emerged as significant and independent predictors of obstructive CAD. CAD prevalence is similar in LBBB patients at low-to-moderate pre-test probability compared with controls with similar CVRF matched for age, gender, and symptom typicality. CCTA is a useful imaging modality in LBBB patients, providing comparable image quality to non-LBBB controls. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  17. Painful left bundle branch block syndrome: Clinical and electrocardiographic features and further directions for evaluation and treatment.

    Science.gov (United States)

    Shvilkin, Alexei; Ellis, Ethan R; Gervino, Ernest V; Litvak, Anthony D; Buxton, Alfred E; Josephson, Mark E

    2016-01-01

    Painful left bundle branch block (LBBB) is a rarely diagnosed chest pain syndrome caused by intermittent LBBB in the absence of myocardial ischemia. Its prevalence, mechanism, detailed electrocardiographic (ECG) features, and effective treatments are not well described. The purpose of this study was to characterize clinical and ECG features of patients with painful LBBB syndrome with respect to the LBBB ECG morphology (in particular QRS axis and the precordial S/T wave ratio), clarify diagnostic criteria and possible mechanisms, and provide directions for further evaluation and treatment. We analyzed clinical (n = 50) and ECG (n = 15) features of patients with painful LBBB syndrome (4 patients in our practice and 46 cases identified in the literature). All 15 ECGs of patients with painful LBBB syndrome had an inferior QRS axis and a very low (<1.8) precordial S/T wave ratio, which was consistent with the "new LBBB" pattern. We report a case of painful LBBB syndrome coexisting with coronary artery disease. Right ventricular apical pacing resolved intractable chest pain in 1 case of painful LBBB. Painful LBBB ECG morphology within seconds/minutes of its onset is consistent with the new LBBB pattern with a very low (<1.8) precordial S/T wave ratio and inferior QRS axis. Painful LBBB syndrome can coexist with coronary artery disease, complicating the assessment of chest pain in the setting of LBBB. An electrophysiology study might be considered to investigate whether changing ventricular activation pattern by pacing provides consistent pain control and to select the most effective pacing configuration. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  18. Prognostic Implication of the QRS Axis and its Association with Myocardial Scarring in Patients with Left Bundle Branch Block

    Science.gov (United States)

    Park, Chan Soon; Cha, Myung-jin; Choi, Eue-Keun

    2017-01-01

    Background and Objectives Left bundle branch block (LBBB) with left axis deviation (LAD) has a worse prognosis than LBBB with a normal axis, and myocardial dysfunction has been suggested as a cause of left axis deviation. This study investigated the prognostic significance of the QRS axis in patients with LBBB and analyzed its relationship with the amount of myocardial scarring. Subjects and Methods A total of 829 patients were diagnosed with LBBB at Seoul National University Hospital from October 2004 to June 2014. Of these, 314 who were asymptomatic and had no previous history of cardiac disease were included in the present study. Myocardial scarring was calculated using the Selvester QRS scoring system, and LAD was defined as a QRS axis between -180° and -30°. Results Of the total patients, 91 (29%) had LAD, and patients were followed for a median of 30 months. During follow-up, two patients were hospitalized for de novo heart failure, four had pacemaker implants, and 10 died. There was a significant inverse correlation between myocardial scar score and the QRS axis (r=-0.356, p<0.001). Patients with concomitant LAD had a higher rate of major cardiac adverse events compared with patients with a normal axis (5.5% vs. 1.3%, log-rank p=0.010); the prognostic value was attenuated in multivariable analysis (hazard ratio 4.117; 95% confidence interval 0.955-17.743; p=0.058). Conclusion Concomitant LAD is an indicator of poor prognosis for patients with LBBB and may be associated with greater myocardial scarring. PMID:28382083

  19. Gender, underutilization of cardiac resynchronization therapy, and prognostic impact of QRS prolongation and left bundle branch block in heart failure.

    Science.gov (United States)

    Linde, Cecilia; Ståhlberg, Marcus; Benson, Lina; Braunschweig, Frieder; Edner, Magnus; Dahlström, Ulf; Alehagen, Urban; Lund, Lars H

    2015-03-01

    It has been suggested that cardiac resynchronization therapy (CRT) is less utilized, dyssynchrony occurs at narrower QRS, and CRT is more beneficial in women compared with men. We tested the hypotheses that (i) CRT is more underutilized and (ii) QRS prolongation and left bundle branch block (LBBB) are more harmful in women. We studied 14 713 patients (28% women) with left ventricular ejection fraction (LVEF) <40% in the Swedish Heart Failure Registry. In women vs. men, CRT was present in 4 vs. 7% (P < 0.001) and was absent but with indication in 30 vs. 31% (P = 0.826). Next, among 13 782 patients (28% women) without CRT, 9% of women and 17% of men had non-specific intraventricular conduction delay (IVCD) and 27% of women and 24% of men had LBBB. One-year survival with narrow QRS was 85% in women and 88% in men, with IVCD 74 and 78%, and with LBBB 84 and 82%, respectively. Compared with narrow QRS, IVCD had a multivariable hazard ratio of 1.24 (95% CI 1.05-1.46, P = 0.011) in women and 1.30 (95% CI 1.19-1.42, P < 0.001) in men, and LBBB 1.03 (95% CI 0.91-1.16, P = 0.651) in women and 1.16 (95% CI 1.07-1.26, P < 0.001) in men, P for interaction between gender and QRS morphology, 0.241. While the proportion with CRT was lower in women, CRT was equally underutilized in both genders. QRS prolongation with or without LBBB was not more harmful in women than in men. Efforts to improve CRT implementation should be directed equally towards women and men. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

  20. QRS duration in left bundle branch block does not affect left ventricular twisting in chronic systolic heart failure.

    Science.gov (United States)

    Attanà, Paola; Paoletti Perini, Alessandro; Votta, Carmine Domenico; Cappelli, Francesco; Pieragnoli, Paolo; Ricciardi, Giuseppe; Nesti, Martina; Giomi, Andrea; Sacchi, Stefania; Chiostri, Marco; Padeletti, Luigi

    2015-11-01

    Left ventricular (LV) torsion is an important parameter of LV performance and can be influenced by several factors. Aim of this investigation was to evaluate whether QRS prolongation in left bundle branch block (LBBB) may influence global LV twist and twisting/untwisting rate in chronic systolic heart failure (HF) patients. We prospectively evaluated 30 healthy subjects (control group) and 100 chronic HF patients with severely impaired LV systolic function (ejection fraction ≤ 35%). Patients were divided into three groups according to QRS duration: A: QRS 150 ms (n 23). Patients in groups B and C presented LBBB. All subjects underwent standard trans-thoracic echocardiography and two-dimensional speckle-tracking echocardiography evaluation. Categorical variables were compared by the chi-square or the Fisher's exact test. Continuous variables were compared using the ANOVA test. Correlations between variables were analysed with linear regression. Control subjects presented higher torsion parameters, when compared with patients in any HF group. Among the three HF groups, no differences were detected in global twist (4.79 ± 3.54, 3.8 ± 3.0 and 4.15 ± 3.14 degrees, respectively), twist rate max (44.81 ± 25.03, 37.94 ± 19.09 and 37.61 ± 24.49 degrees s(-1), respectively) and untwist rate max (-36.31 ± 30.89, -27.68 ± 34.67 and -39.62 ± 26.27 degrees s(-1), respectively) (P>0.05 for all). At linear regression analysis, there was no relation between QRS duration and any torsion parameter (P>0.05 for all). In patients with chronic severe systolic heart failure, QRS duration and LBBB morphology do not affect LV twisting and untwisting. © 2014 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  1. Right Bundle Branch Block-Like Pattern During Uncomplicated Right Ventricular Pacing and the Effect of Pacing Site.

    Science.gov (United States)

    Tzeis, Stylianos; Andrikopoulos, George; Weigand, Severin; Grebmer, Christian; Semmler, Verena; Brkic, Amir; Asbach, Stefan; Kloppe, Axel; Lennerz, Carsten; Bourier, Felix; Pastromas, Sokratis; Kolb, Christof

    2016-03-15

    Right bundle branch block (RBBB) configuration is an unexpected finding during right ventricular (RV) pacing that raises the suspicion of inadvertent left ventricular lead positioning. The aim of this study was to evaluate the prevalence of paced RBBB pattern in relation to RV lead location. This is a secondary analysis of a prospective, multicenter study, which randomized implantable cardioverter defibrillator recipients to an apical versus midseptal defibrillator lead positioning. A 12-lead electrocardiogram was recorded during intrinsic rhythm and RV pacing. Paced RBBB-like pattern was defined as positive (>0.05 mV) net amplitude of QRS complex in leads V1 and/or V2. In total, 226 patients (65.6 ± 12.0 years, 20.8% women, 53.1% apical site) were included in the study. The prevalence of paced RBBB pattern in the total population was 15.5%. A significantly lower percentage of patients in the midseptal group demonstrated RBBB-type configuration during RV pacing compared with the apical group (1.9% vs 27.5%, p <0.001). Baseline RBBB, prolonged QRS duration during intrinsic rhythm, and reduced ejection fraction were not associated with increased likelihood of paced RBBB. In the subgroup of patients with RBBB type during pacing, 91.4% of patients had a paced QRS axis from -30° to -90°, whereas 100% of patients displayed a negative QRS vector at lead V3. In conclusion, RBBB configuration is encountered in a considerable percentage of device recipients during uncomplicated RV pacing. Midseptal lead positioning is associated with significantly lower likelihood of paced RBBB pattern compared with apical location. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure?

    Science.gov (United States)

    Karadeniz, Cem; Atalay, Semra; Demir, Fikri; Tutar, Ercan; Ciftci, Omer; Ucar, Tayfun; Uysalel, Adnan; Eyileten, Zeynep

    2015-03-01

    In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically lower [corrected] tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.

  3. Assessment of Smith Algorithms for the Diagnosis of Acute Myocardial Infarction in the Presence of Left Bundle Branch Block.

    Science.gov (United States)

    Di Marco, Andrea; Anguera, Ignasi; Rodríguez, Marcos; Sionis, Alessandro; Bayes-Genis, Antoni; Rodríguez, Jany; Ariza-Solé, Albert; Sánchez-Salado, José Carlos; Díaz-Nuila, Mario; Masotti, Mónica; Villuendas, Roger; Dallaglio, Paolo; Gómez-Hospital, Joan Antoni; Cequier, Ángel

    2017-07-01

    Recently, a new electrocardiography algorithm has shown promising results for the the diagnosis of acute myocardial infarction in the presence of left bundle branch block (LBBB). We aimed to assess these new electrocardiography rules in a cohort of patients referred for primary percutaneous coronary intervention (pPCI). Retrospective observational cohort study that included all patients with suspected myocardial infarction and LBBB on the presenting electrocardiogram, referred for pPCI to 4 tertiary hospitals in Barcelona, Spain. A total of 145 patients were included. Fifty four (37%) had an ST-segment elevation myocardial infarction (STEMI) equivalent. Among patients with STEMI, 25 (46%) presented in Killip class III or IV, and in-hospital mortality was 15%. Smith I and II rules performed better than Sgarbossa algorithms and showed good specificity (90% and 97%, respectively) but their sensitivity was 67% and 54%, respectively. In a strategy guided by Smith I or Smith II rules, 18 (33%) or 25 (46%) patients with STEMI would have not received a pPCI, respectively. Moreover, the severity and prognosis of STEMI patients was similar regardless of the positivity of Smith rules. Cardiac biomarkers were positive in 54% of non-STEMI patients, limiting their usefulness for initial diagnostic screening. Diagnosis of STEMI in the presence of LBBB remains a challenge. Smith rules can be useful but are limited by suboptimal sensitivity. The search for new electrocardiography algorithms should be encouraged to avoid unnecessary aggressive treatments in the majority of patients, while providing timely reperfusion to a high-risk subgroup of patients. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Bundle Branch Block

    Science.gov (United States)

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  5. Relation of New Permanent Right or Left Bundle Branch Block on Short- and Long-Term Mortality in Acute Myocardial Infarction Bundle Branch Block and Myocardial Infarction.

    Science.gov (United States)

    Melgarejo-Moreno, Antonio; Galcerá-Tomás, José; Consuegra-Sánchez, Luciano; Alonso-Fernández, Nuria; Díaz-Pastor, Ángela; Escudero-García, Germán; Jaulent-Huertas, Leticia; Vicente-Gilabert, Marta; Galcerá-Jornet, Emilio; Padilla-Serrano, Antonio; de Gea-García, José; Pinar-Bermudez, Eduardo

    2015-10-01

    The aim of this study was to investigate the prognosis associated with bundle branch block (BBB) depending on location, time of appearance, and duration in patients with myocardial infarction (MI). From January 1998 to January 2008, we recruited 5,570 patients with acute MI. Thirty-day and 7-year all-cause mortality, according to BBB location, time of appearance, and duration were analyzed by multivariable analyses. BBB was present in 964 patients (17.3%); right BBB (RBBB) 10.6% and left BBB (LBBB) 6.7%. Overall mortality rate at 30 days was 13.2% (n = 738) and 7 years was 6.34 deaths per 100 patient-year. Both RBBB and LBBB were more frequently previous, 42.9% and 58.8%. Compared with non-BBB, all BBB groups showed higher prevalence of co-morbidities, especially rates of diabetes (49.0% vs 34.3%, p <0.001) and more often heart failure during hospitalization (54.5% vs 26.6%, p <0.001). Compared with RBBB, patients with LBBB had a higher prevalence of co-morbidities and a higher mortality, especially the new BBB, 30 days: 52.5% versus 31.6% and 7 years (incident rate): 27.2 versus 13.3 per 100 patient-year. New transient BBB had lower heart failure on admission (42.6% vs 58.3%, p = 0.008) and 30-day mortality (20.3% vs 69.6%, p <0.001) compared with permanent in both locations. New permanent RBBB was independently associated with 30-day (hazard ratio [HR] 2.01, 95% confidence interval [CI] 1.45 to 2.79) and 7-year mortality (HR 3.12, 95% CI 2.38 to 4.09). New-permanent LBBB was independently associated with 30-day (HR 2.15, 95% CI 1.47 to 3.15) and 7-year mortality (HR 2.91, 95% CI 2.08 to 4.08). In conclusion, in patients with acute MI, the appearance of a new BBB was independently associated with a higher 30-day and 7-year all-cause mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Clinical and angiographic importance of right bundle branch block in the setting of acute anterior myocardial infarction.

    Science.gov (United States)

    Arslan, Uğur; Balcioğlu, Serhat; Tavil, Yusuf; Ozdemir, Murat; Cengel, Atiye

    2008-04-01

    To investigate functional status of patients (Killip class), left ventricular contractility, angiographic anatomy and severity of coronary lesions in patients with and without right bundle branch block (RBBB) in the setting of anterior myocardial infarction (MI). Patients who admitted to coronary care unit with the diagnosis of acute anterior MI between 1999 and 2005 were retrospectively searched from our database. Out of 792 patients, 37 had RBBB (RBBB group) either at admission or in the course of anterior MI. Forty patients who developed no intraventricular conduction defect during the course of anterior MI with the same demographic characteristics were selected as the control group. Out of 37 patients, 30 had RBBB on admission and 7 developed RBBB in the course of acute MI. Left anterior descending artery (LAD) proximal lesion was more commonly detected in the RBBB group [23 (62.2%) vs. 11 (27.5%) patients, p=0.003]. Left ventricular ejection fraction was lower (33.0+/-4.2% vs 36.7+/-4.9%, p=0.003) and end-systolic volume was higher (84.1+/-24.9 ml vs 74.6+/-22.0 ml, p=0.012) in patients with RBBB. Number of patients with high Killip grade (III and IV) was more in the RBBB group [7 (18.9%) vs 3 (7.5%), RR: 1.75, %95 CI 0.92-3.32, p=0.14], and number of patients with Killip grade I was more in the control group [34 (85.0%) vs 22 (59.5%), p=0.012]. Besides mean Killip class was higher in the RBBB group (1.65+/-0.90 vs 1.25+/-0.67, p=0.03). Three patients (8.1%) in the RBBB group and 2 patients (5.0%) in the control group died during hospitalization (p=0.67). Left ventricular ejection fraction decreases and Killip grade increases in case of RBBB in the setting of acute anterior MI. Culprit lesion in patients with RBBB is more commonly a LAD proximal lesion and threatened myocardial tissue is larger in patients with RBBB.

  7. Outcomes With Left Bundle Branch Block and Mildly to Moderately Reduced Left Ventricular Function.

    Science.gov (United States)

    Witt, Chance M; Wu, Gang; Yang, Dachun; Hodge, David O; Roger, Veronique L; Cha, Yong-Mei

    2016-11-01

    This study aimed to define the prognosis for patients with left bundle branch block (LBBB) and a mildly to moderately reduced left ventricular ejection fraction (LVEF) (36% to 50%) as well as to clarify whether LBBB remained a negative prognostic marker in this group. LBBB is associated with worse outcomes in patients with heart failure in the setting of severely reduced LVEF. The level of morbidity and mortality associated with LBBB in the setting of a mildly to moderately reduced LVEF (36% to 50%) has not been clearly characterized. This knowledge is important to clarify the potential benefit of cardiac resynchronization therapy in this group. All patients identified as having an LBBB from 1994 to 2014 were included in the study if they had a baseline echocardiogram within 1 year and an LVEF between 36% and 50%. A control group without intraventricular conduction abnormality matched on age, sex, baseline LVEF, and date of echocardiogram was created. Outcomes were compared between the 2 groups. Of 1,436 patients meeting inclusion criteria, 54% were male. Mean age was 67 ± 13 years, and mean LVEF at baseline was 44 ± 4%. There was no difference in baseline heart failure diagnosis between groups. There were significantly higher rates of baseline coronary artery disease in the control group and higher rates of aortic stenosis in the LBBB group. LBBB was associated with significantly worse mortality (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.00 to 1.36), an LVEF drop to 35% or less (HR: 1.34; 95% CI: 1.09 to 1.63), and the need for an implantable cardioverter-defibrillator (HR: 1.50; 95% CI: 1.10 to 2.10). Mortality remained significantly higher in the LBBB group when controlled for heart failure, coronary artery disease, and aortic stenosis (p = 0.04). Patients with a mildly to moderately reduced LVEF and LBBB have poor clinical outcomes that are significantly worse than those for patients without conduction system disease. This group may obtain

  8. Assessment of left ventricular mechanical dyssynchrony in left bundle branch block canine model: Comparison between cine and tagged MRI.

    Science.gov (United States)

    Saporito, Salvatore; van Assen, Hans C; Houthuizen, Patrick; Aben, Jean-Paul M M; Strik, Marc; van Middendorp, Lars B; Prinzen, Frits W; Mischi, Massimo

    2016-10-01

    To compare cine and tagged magnetic resonance imaging (MRI) for left ventricular dyssynchrony assessment in left bundle branch block (LBBB), using the time-to-peak contraction timing, and a novel approach based on cross-correlation. We evaluated a canine model dataset (n = 10) before (pre-LBBB) and after induction of isolated LBBB (post-LBBB). Multislice short-axis tagged and cine MRI images were acquired using a 1.5 T scanner. We computed contraction time maps by cross-correlation, based on the timing of radial wall motion and of circumferential strain. Finally, we estimated dyssynchrony as the standard deviation of the contraction time over the different regions of the myocardium. Induction of LBBB resulted in a significant increase in dyssynchrony (cine: 13.0 ± 3.9 msec for pre-LBBB, and 26.4 ± 5.0 msec for post-LBBB, P = 0.005; tagged: 17.1 ± 5.0 msec at for pre-LBBB, and 27.9 ± 9.8 msec for post-LBBB, P = 0.007). Dyssynchrony assessed by cine and tagged MRI were in agreement (r = 0.73, P = 0.0003); differences were in the order of time difference between successive frames of 20 msec (bias: -2.9 msec; limit of agreement: 10.1 msec). Contraction time maps were derived; agreement was found in the contraction patterns derived from cine and tagged MRI (mean difference in contraction time per segment: 3.6 ± 13.7 msec). This study shows that the proposed method is able to quantify dyssynchrony after induced LBBB in an animal model. Cine-assessed dyssynchrony agreed with tagged-derived dyssynchrony, in terms of magnitude and spatial direction. J. MAGN. RESON. IMAGING 2016;44:956-963. © 2016 International Society for Magnetic Resonance in Medicine.

  9. The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling.

    Science.gov (United States)

    Dobson, Laura E; Musa, Tarique A; Uddin, Akhlaque; Fairbairn, Timothy A; Bebb, Owen J; Swoboda, Peter P; Haaf, Philip; Foley, James; Garg, Pankaj; Fent, Graham J; Malkin, Christopher J; Blackman, Daniel J; Plein, Sven; Greenwood, John P

    2017-02-22

    Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m 2 , p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB

  10. Left Bundle Branch Block Negatively Affects Coronary Flow Velocity Reserve and Myocardial Contractile Reserve in Nonischemic Dilated Cardiomyopathy.

    Science.gov (United States)

    Ciampi, Quirino; Cortigiani, Lauro; Pratali, Lorenza; Rigo, Fausto; Villari, Bruno; Picano, Eugenio; Sicari, Rosa

    2016-02-01

    Coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery (LAD) and myocardial contractile reserve are often impaired in nonischemic dilated cardiomyopathy (DCM). Whether they are affected by the presence of left bundle branch block (LBBB) remains unaddressed. The aim of the study was to investigate how LBBB influences CFVR of the LAD and myocardial contractile reserve in patients with DCM. One hundred eighty-one patients with DCM (116 men; mean age, 63 ± 12 years) underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echocardiography with CFVR evaluation of the LAD by Doppler. All patients had ejection fractions  2.0 was considered normal. Inotropic reserve was defined as rest-stress variation in wall motion score index ≥ 0.20. This was a prospective analysis of an unselected sample consecutively enrolled and retrospectively selected. The study group was separated on the basis of presence (n = 122) or absence (n = 59) of LBBB. Patients with LBBB were older (64 ± 11 vs 59 ± 12 years, P = .004) and had reduced resting ejection fractions (30 ± 9% vs 33 ± 7%, P = .02), CFVR of the LAD (1.96 ± 0.41 vs 2.23 ± 0.73, P = .001), and myocardial contractile reserve (variation in wall motion score index, -0.18 ± 0.17 vs -0.33 ± 0.28; P < .001). On multivariate logistic regression analysis, resting ejection fraction (hazard ratio [HR], 1.15; 95% CI, 1.03-1.29; P = .01), smoking habit (HR, 2.63; 95% CI, 1.23-5.62; P = .01), and LBBB (HR, 2.29; 95% CI, 1.05-5.04; P = .04) were independently associated with reduced CFVR, while restrictive transmitral pattern (HR, 2.56; 95% CI, 1.18-5.55; P = .02), end-diastolic volume (HR, 0.98; 95% CI, 0.67-0.99; P = .02), and LBBB (HR, 2.20; 95% CI, 1.11-4.34; P = .02) independently predicted reduced myocardial contractile reserve. CFVR during vasodilator stress echocardiography is a suitable tool for assessing microvascular dysfunction in routine

  11. Trastuzumab (Herceptin)-associated cardiomyopathy presented as new onset of complete left bundle-branch block mimicking acute coronary syndrome: a case report and literature review.

    Science.gov (United States)

    Tu, Chung-Ming; Chu, Kai-Ming; Yang, Shin-Ping; Cheng, Shu-Mung; Wang, Wen-Been

    2009-09-01

    Trastuzumab (Herceptin) is well documented in reducing suffering and mortality from breast cancer. The clinically most important side effect of Herceptin is cardiotoxicity, which is reported in 2.6% to 4.5% of patients receiving trastuzumab alone and in as many as 27% of patients when trastuzumab is combined with an anthracycline in metastatic disease. We reported the case of a 50-year-old woman who presented to our emergency department (ED) because of chest pain and shortness of breath. On physical examination, holosystolic murmur over apex could be heard. Pulmonary and abdominal examinations were unremarkable. Twelve-lead electrocardiography showed sinus tachycardia and new onset of complete left bundle-branch block. Emergent transthoracic echocardiography revealed generalized hypokinesia of left ventricle and akinesia over interventricular septum and apex. She subsequently underwent immediate coronary angiography that revealed normal coronary angiography, and left ventriculogram revealed generalized hypokinesia with severe left ventricle dysfunction with ejection fraction of 33%. During right heart catheterization and endomyocardial biopsy, cardiac tamponade developed and was successfully relieved by pericardial window. She was discharged event-free 3 weeks later with conservative treatment. Although new onset of complete left bundle-branch block in a patient with chest pain may be acute coronary syndrome, careful review of medicine history is mandatory to avoid unnecessary procedure and complications.

  12. QRS frequency characteristics help predict response to cardiac resynchronization in left bundle branch block less than 150 milliseconds.

    Science.gov (United States)

    Niebauer, Mark J; Rickard, John; Polakof, Landon; Tchou, Patrick J; Varma, Niraj

    2014-12-01

    Baseline QRS duration (QRSd) ≥150 ms is a recognized predictor of clinical improvement by cardiac resynchronization therapy (CRT), particularly for those with left bundle branch (LBBB). Patients with QRSd 52% below 10 Hz was especially predictive of response in those with QRSd <150 ms. In these patients, this power threshold was highly predictive of CRT response (positive predictive value 85.7%, negative predictive value 71.4%). In this group of CRT recipients with LBBB, retrospective analysis of QRS frequency content below 10 Hz had greater predictive value for CRT response than baseline QRSd, particularly in those with QRSd <150 ms. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  13. Sequential SPECT/CT imaging starting with stress SPECT in patients with left bundle branch block suspected for coronary artery disease.

    Science.gov (United States)

    Engbers, Elsemiek M; Timmer, Jorik R; Mouden, Mohamed; Knollema, Siert; Jager, Pieter L; Ottervanger, Jan Paul

    2017-01-01

    To investigate the impact of left bundle branch block (LBBB) on sequential single photon emission computed tomography (SPECT)/ CT imaging starting with stress-first SPECT. Consecutive symptomatic low- to intermediate-risk patients without a history of coronary artery disease (CAD) referred for SPECT/CT were included from an observational registry. If stress SPECT was abnormal, additional rest SPECT and, if feasible, coronary CT angiography (CCTA) were acquired. Of the 5,018 patients, 218 (4.3 %) demonstrated LBBB. Patients with LBBB were slightly older than patients without LBBB (65±12 vs. 61±11 years, pbundle branch block patients have abnormal stress-first SPECT. • Coronary CT excluded obstructive CAD in many LBBB patients with abnormal SPECT. • Stress-first SPECT imaging is not the optimal imaging protocol in LBBB patients. • In LBBB patients imaging with initial coronary CT may be more appropriate.

  14. Severe conduction defects requiring permanent pacemaker implantation in patients with a new-onset left bundle branch block after transcatheter aortic valve implantation.

    Science.gov (United States)

    Nijenhuis, V J; Van Dijk, V F; Chaldoupi, S M; Balt, J C; Ten Berg, J M

    2017-06-01

    Transcatheter aortic valve implantation (TAVI) is frequently associated with cardiac conduction defects (CCD) requiring permanent pacemaker implantation (PPI). Although new-onset left bundle branch block (LBBB) is often seen, the rate of progression to severe CCD is unclear. We aimed to find clinical and electrocardiographic (ECG) parameters associated with severe CCD requiring PPI in patients with a new-onset LBBB after TAVI and assess its effect on clinical outcome. All consecutive patients undergoing TAVI who developed a new-onset LBBB were retrospectively analysed. We excluded patients with pre-existing bundle branch block or pacemaker. Patients were divided into two groups: with or without PPI after TAVI. We included 155 patients (50% female, 80 ± 7 years), of which 37 (24%) developed CCD requiring PPI, mainly due to a total atrioventricular block (n = 17; 46%). Cardiac conduction defects requiring PPI were associated with the following pre-existing parameters: atrial fibrillation (AF), the use of digoxin, CoreValve implantation, and left heart axis. Furthermore, it was associated with the following post-procedural parameters: left heart axis, lower mean heart rate, and prolonged PQ and QRS times. During follow-up, patients with PPI showed a lower mortality rate (11 vs. 29%, P = 0.03). In patients without PPI, mortality was lower in those with narrower QRS complex and transient LBBB. The severity and persistence of a new-onset LBBB after TAVI is associated with mortality. Cardiac conduction defects requiring PPI are associated with prior AF, the use of digoxin, CoreValve implantation, and a left heart axis. In these patients, PPI portends a better prognosis than no PPI.

  15. Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: the VALIANT experience

    DEFF Research Database (Denmark)

    Stephenson, Kent; Skali, Hicham; McMurray, John J V

    2006-01-01

    BACKGROUND: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). OBJECTIVES: The aim of this study...... was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. METHODS: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized...... to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. RESULTS...

  16. Do patients with heart failure and right bundle branch block need biventricular pacing? A case of significant QRS narrowing by right ventricular pacing alone.

    Science.gov (United States)

    Crea, Pasquale; Andò, Giuseppe; Zagari, Domenico; Giordano, Antonio; Picciolo, Giuseppe; Oreto, Giuseppe

    2015-01-01

    We report the case of a 56-year-old male with ischemic cardiomyopathy, severe left ventricular dysfunction and right bundle branch block (RBBB) with a wide QRS duration (180ms) who received dual-chamber implantable cardioverter-defibrillator for primary prevention of sudden death. After having placed the right ventricular lead in the middle of the inter-ventricular septum, a significant narrowing of QRS duration was observed, thus obtaining "de facto" a cardiac resynchronization therapy (CRT). This type of cardiac pacing could be an alternative to conventional CRT with left ventricular pacing in patients with wide QRS due to RBBB. The long-term effects of this RV only pacing strategy with ICD in patients with heart failure yet remain to be determined. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Cardiac resynchronization therapy for exercise-induced left ventricular dysfunction in the setting of left bundle branch block: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    JoEllyn M. Abraham, MD

    2014-12-01

    Full Text Available Exercise-induced dyspnea is one of the most common symptoms that cause a patient to see a physician and a broad differential diagnosis is required. In this case report, we describe a patient with this complaint who had a left bundle branch block and preserved left ventricular function at rest. On stress echocardiography, she had significant exercise-induced left ventricular dysfunction and associated mitral regurgitation but a coronary angiogram demonstrated normal coronary arteries. Both of the echocardiographic findings, as well as her symptoms, improved with the placement of a bi-ventricular pacemaker. A brief review of the literature on cardiac resynchronization therapy for indications beyond the current guidelines is also provided.

  18. Outcome after implantation of cardiac resynchronization/defibrillation systems in patients with congestive heart failure and left bundle-branch block.

    Science.gov (United States)

    Pfau, Giselher; Schilling, Thomas; Kozian, Alf; Lux, Anke; Götte, A; Huth, Christof; Hachenberg, Thomas

    2010-02-01

    The implantation of cardiac resynchronization/defibrillation devices (CRT-Ds) increasingly is used in patients with congestive heart failure and left bundle-branch block. There are no data on the effects of anesthesia and surgery on outcome after implantation. A retrospective, observational study; postoperative survey. University hospital. Three hundred forty-one patients (258 men/83 women, 63 +/- 9 years) with congestive heart failure and left bundle-branch block who underwent CRT-D implantation in 1996 to 2005. Perioperative data were retrieved from the patients' records. Cardiologists caring for the patients were contacted to obtain information on current New York Heart Association (NYHA) status and mortality after CRT-D implantation. Preoperatively, 45 patients were classified as NYHA II, 246 as NYHA III, and 50 as NYHA IV. CRT was performed via thoracotomy in 100 and transvenously in 241 cases. General anesthesia (propofol or sevoflurane and remifentanil) was performed in 273 and local anesthesia (lidocaine) in 68 patients. Hypotension occurred mainly during general anesthesia (43% v 4%). The 30-day mortality was 0%. The postoperative survey started in 2006 and was completed by 215 patients. The mean survival time was 77 months; 151 patients survived the study period. Outcome was not influenced by local and general anesthesia. Presence of preoperative NYHA class >II (odds ratio [OR] = 1.6, confidence interval [CI] = 0.5-5.1), mitral regurgitation (OR = 2.5, CI = 1.2-5.5), and serum creatinine >1.1 mg/dL (OR = 3.0, CI = 1.5-6.2) resulted in an inferior prognosis. In patients with severely impaired cardiac function, general anesthesia for the implantation of a biventricular pacing device can be used with justifiable risk. The method of anesthesia did not influence outcome. Copyright 2010 Elsevier Inc. All rights reserved.

  19. Longer right to left ventricular activation delay at cardiac resynchronization therapy implantation is associated with improved clinical outcome in left bundle branch block patients.

    Science.gov (United States)

    Kosztin, Annamaria; Kutyifa, Valentina; Nagy, Vivien Klaudia; Geller, Laszlo; Zima, Endre; Molnar, Levente; Szilagyi, Szabolcs; Ozcan, Emin Evren; Szeplaki, Gabor; Merkely, Bela

    2016-04-01

    Data on longer right to left ventricular activation delay (RV-LV AD) predicting clinical outcome after cardiac resynchronization therapy (CRT) by left bundle branch block (LBBB) are limited. We aimed to evaluate the impact of RV-LV AD on N-terminal pro-B-type natriuretic peptide (NT-proBNP), ejection fraction (EF), and clinical outcome in patients implanted with CRT, stratified by LBBB at baseline. Heart failure (HF) patients undergoing CRT implantation with EF ≤ 35% and QRS ≥ 120 ms were evaluated based on their RV-LV AD at implantation. Baseline and 6-month clinical parameters, EF, and NT-proBNP values were assessed. The primary endpoint was HF or death, the secondary endpoint was all-cause mortality. A total of 125 patients with CRT were studied, 62% had LBBB. During the median follow-up of 2.2 years, 44 (35%) patients had HF/death, 36 (29%) patients died. Patients with RV-LV AD ≥ 86 ms (lower quartile) had significantly lower risk of HF/death [hazard ratio (HR): 0.44; 95% confidence interval (95% CI): 0.23-0.82; P = 0.001] and all-cause mortality (HR: 0.48; 95% CI: 0.23-1.00; P = 0.05), compared with those with RV-LV AD bundle branch block patients with longer RV-LV activation delay at CRT implantation had greater improvement in NT-proBNP, EF, and significantly better clinical outcome. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  20. Prominent R wave in ECG lead V1 predicts improvement of left ventricular ejection fraction after cardiac resynchronization therapy in patients with or without left bundle branch block.

    Science.gov (United States)

    Bode, Weeranun D; Bode, Michael F; Gettes, Leonard; Jensen, Brian C; Mounsey, John P; Chung, Eugene H

    2015-10-01

    QRS morphology on postprocedural ECG indicating posterolateral left ventricular pacing may be predictive of response to cardiac resynchronization therapy (CRT). The purpose of this study was to assess whether a positive vector in V1 and/or negative vector in lead I on the first postprocedural ECG, suggesting posterolateral capture from CRT, correlates with improvement in left ventricular ejection fraction (LVEF). A retrospective chart review was conducted on all patients who underwent CRT implantation at our institution between April 2008 and December 2011. Biventricular (BiV) paced QRS morphology was defined as R/S ≥1 in V1 and/or R/S ≤ 1 in lead I. The primary outcome was improvement of LVEF ≥7.5%. The χ(2) and t tests were used for analysis. Of 68 patients, 49 (72%) met our BiV paced QRS morphology criteria. Thirty-four of these 49 patients (69%) had improvement in LVEF. Of the 19 patients who did not meet our criteria, 17 (89%) did not have an improvement in LVEF (sensitivity 94%, specificity 53%, χ(2) = 19.04, P bundle branch block was not a predictor of echocardiographic response. Our results highlight the importance of periprocedural ECG analysis to optimize response to CRT. Moreover, patients without left bundle branch block still benefited from CRT if they met our BiV paced morphology criteria. This suggests that postprocedural left ventricular activation as reflected on the ECG may supersede the baseline conduction delay. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  1. [Supernormal and alternating conduction in intermittent bundle branch block and intermittent or concealed ventricular preexcitation. Electrophysiological study, mechanisms and clinical considerations].

    Science.gov (United States)

    Costantini, Marcello

    2016-05-01

    Supernormal and alternating conduction are not rare in clinical arrhythmology, detectable at various levels of the conduction system in different pathophysiological conditions, and often associated, so as to justify the search for a possible link between them. In order to define a possible relationship between supernormal and alternating conduction, the electrophysiological data of two patient groups were analyzed. Group 1 included 9 patients with intermittent bundle branch block in the presence of supernormal conduction through the pathological branch. Group 2 included 16 patients with ventricular preexcitation, intermittent or concealed, in the presence of supernormal conduction through the atrioventricular accessory pathway. In group 1, 8 patients had a phase 3 and 1 patient a phase 3 and phase 4 bundle branch block. In all 9 patients, the area of phase 3 block was interrupted by a window of unexpected conductivity detectable by atrial premature stimulation. In 7/9 cases, by modulating the atrial rate, alternating conduction through the branch was observed, and the cardiac cycle of occurrence of the phenomenon was in the range of supernormal conduction in 6/7 cases. In group 2, 11 patients showed conduction through the accessory pathway only for a narrow range of cardiac cycles, during atrial premature stimulation. One patient had a prolonged accessory pathway refractory period (phase 3 block), but a window of unexpected supernormal conduction within the refractory zone was observed at atrial premature stimulation. Another patient presented a tachycardia and bradycardia-dependent block along the accessory pathway (phase 3 and phase 4 block) and the phase 3 block area was interrupted by a window of supernormal conduction. In the other three cases, supernormal conduction was manifested as unexpected resumption of conductivity through the accessory pathway for atrial cycles more precocious than the actual duration of its effective refractoriness. By modulating the

  2. Usefulness of His Bundle Pacing to Achieve Electrical Resynchronization in Patients With Complete Left Bundle Branch Block and the Relation Between Native QRS Axis, Duration, and Normalization.

    Science.gov (United States)

    Teng, Alexandra E; Lustgarten, Daniel L; Vijayaraman, Pugazhendhi; Tung, Roderick; Shivkumar, Kalyanam; Wagner, Galen S; Ajijola, Olujimi A

    2016-08-15

    His Bundle pacing (HBP) restores electrical synchronization in left bundle branch block (LBBB); however, the underlying mechanisms are poorly understood. We examined the relation between native QRS axis in LBBB, a potential indicator of the site of block, and QRS normalization in patients with LBBB. Data from patients (n = 41) undergoing HBP at 3 sites were studied (68 ± 13 years, 13 women). Study criteria included strictly defined complete LBBB and successful implantation of a permanent HBP lead. Preprocedure and postprocedure electrocardiograms were reviewed independently by 2 blinded readers. QRS axis and duration were measured to the nearest 10° and 10 ms, respectively. QRS narrowing or normalization was the primary end point. Of 29 patients meeting study criteria, 9 had frontal plane QRS axes between -60° and -80°, 10 from -40° to 0°, and 10 from +1° to +90°. QRS narrowing occurred in 24 patients (83%, 44 ± 34 ms, p block causes most cases of LBBB, or that additional mechanisms underlie HBP efficacy. Further studies are needed to better understand how to predict those patients in whom HBP will normalize LBBB. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. PR interval identifies clinical response in patients with non-left bundle branch block: a Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy substudy.

    Science.gov (United States)

    Kutyifa, Valentina; Stockburger, Martin; Daubert, James P; Holmqvist, Fredrik; Olshansky, Brian; Schuger, Claudio; Klein, Helmut; Goldenberg, Ilan; Brenyo, Andrew; McNitt, Scott; Merkely, Bela; Zareba, Wojciech; Moss, Arthur J

    2014-08-01

    In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), patients with non-left bundle branch block (LBBB; including right bundle branch block, intraventricular conduction delay) did not have clinical benefit from cardiac resynchronization therapy with defibrillator (CRT-D). We hypothesized that baseline PR interval modulates clinical response to CRT-D therapy in patients with non-LBBB. Non-LBBB patients (n=537; 30%) were divided into 2 groups based on their baseline PR interval as normal (including minimally prolonged) PR (PR <230 ms) and prolonged PR (PR ≥230 ms). The primary end point was heart failure or death. Separate secondary end points included heart failure events and all-cause mortality. Cox proportional hazards regression models were used to compare risk of end point events by CRT-D to implantable cardioverter defibrillator therapy in the PR subgroups. There were 96 patients (22%) with a prolonged PR and 438 patients (78%) with a normal PR interval. In non-LBBB patients with a prolonged PR interval, CRT-D treatment was associated with a 73% reduction in the risk of heart failure/death (hazard ratio, 0.27; 95% confidence interval, 0.13-0.57; P<0.001) and 81% decrease in the risk of all-cause mortality (hazard ratio, 0.19; 95% confidence interval, 0.13-0.57; P<0.001) compared with implantable cardioverter defibrillator therapy. In non-LBBB patients with normal PR, CRT-D therapy was associated with a trend toward an increased risk of heart failure/death (hazard ratio, 1.45; 95% confidence interval, 0.96-2.19; P=0.078; interaction P<0.001) and a more than 2-fold higher mortality (hazard ratio, 2.14; 95% confidence interval, 1.12-4.09; P=0.022; interaction P<0.001) compared with implantable cardioverter defibrillator therapy. The data support the use of CRT-D in MADIT-CRT non-LBBB patients with a prolonged PR interval. In non-LBBB patients with a normal PR interval, implantation of a CRT-D may be deleterious

  4. Usefulness of His Bundle Pacing to Achieve Electrical Resynchronization in Patients with Complete Left Bundle Branch Block and the Relation Between Native QRS Axis, Duration, and Normalization

    Science.gov (United States)

    Teng, Alexandra E.; Lustgarten, Daniel L.; Vijayaraman, Pugazhendhi; Tung, Roderick; Shivkumar, Kalyanam; Wagner, Galen S.; Ajijola, Olujimi A.

    2016-01-01

    His Bundle pacing (HBP) restores electrical synchronization in left bundle branch block (LBBB), however, the underlying mechanisms are poorly understood. We examined the relationship between native QRS axis in LBBB, a potential indicator of the site of block, and QRS normalization in patients with LBBB. Data from patients (n=41) undergoing HBP at three sites were studied (68±13 years, 13 females). Study criteria included strictly defined complete LBBB, and successful implantation of a permanent HBP lead. Pre- and post-procedure electrocardiograms were reviewed independently by two blinded readers. QRS axis and duration were measured to the nearest 10° and 10ms, respectively. QRS narrowing or normalization was the primary endpoint. Of 29 patients meeting study criteria, 9 had frontal plane QRS axes between −60° and −80°, 10 from −40° to 0°, and 10 from +1° to +90°. QRS narrowing occurred in 24 patients (83%, 44±34ms, pblock causes most cases of LBBB, or that additional mechanisms underlie HBP efficacy. Further studies are needed to better understand how to predict those patients in whom HBP will normalize LBBB. PMID:27344272

  5. A case of an infant with bundle branch reentrant ventricular tachycardia

    Directory of Open Access Journals (Sweden)

    Satoki Fujii

    2012-04-01

    Full Text Available Catheter ablation of the right bundle branch was performed on an 11-month-old infant for the treatment of drug-resistant bundle branch reentrant ventricular tachycardia. The occurrence of right bundle branch block could not be used as an endpoint of treatment because the patient had presented with incomplete right bundle branch block pattern during sinus rhythm. We performed ablation of the right bundle branch and utilized changes of duration and morphology of the QRS complex as indicators. Eight years have passed with no development of any atrioventricular block or tachycardia episode.

  6. Sequential SPECT/CT imaging starting with stress SPECT in patients with left bundle branch block suspected for coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Engbers, Elsemiek M.; Mouden, Mohamed [Isala, Department of Cardiology, Zwolle (Netherlands); Isala, Department of Nuclear Medicine, Zwolle (Netherlands); Timmer, Jorik R.; Ottervanger, Jan Paul [Isala, Department of Cardiology, Zwolle (Netherlands); Knollema, Siert; Jager, Pieter L. [Isala, Department of Nuclear Medicine, Zwolle (Netherlands)

    2017-01-15

    To investigate the impact of left bundle branch block (LBBB) on sequential single photon emission computed tomography (SPECT)/ CT imaging starting with stress-first SPECT. Consecutive symptomatic low- to intermediate-risk patients without a history of coronary artery disease (CAD) referred for SPECT/CT were included from an observational registry. If stress SPECT was abnormal, additional rest SPECT and, if feasible, coronary CT angiography (CCTA) were acquired. Of the 5,018 patients, 218 (4.3 %) demonstrated LBBB. Patients with LBBB were slightly older than patients without LBBB (65±12 vs. 61±11 years, p<0.001). Stress SPECT was more frequently abnormal in patients with LBBB (82 % vs. 46 %, p<0.001). After reviewing stress and rest images, SPECT was normal in 43 % of the patients with LBBB, compared to 77 % of the patients without LBBB (p<0.001). Sixty-four of the 124 patients with LBBB and abnormal stress-rest SPECT underwent CCTA (52 %), which could exclude obstructive CAD in 46 of the patients (72 %). Sequential SPECT/CT imaging starting with stress SPECT is not the optimal imaging protocol in patients with LBBB, as the majority of these patients have potentially false-positive stress SPECT. First-line testing using CCTA may be more appropriate in low- to intermediate-risk patients with LBBB. (orig.)

  7. The prognostic value of a new left bundle branch block in patients with acute myocardial infarction: A systematic review and meta-analysis.

    Science.gov (United States)

    Al Rajoub, Belal; Noureddine, Samar; El Chami, Samer; Haidar, Mohamad Hussein; Itani, Bachir; Zaiter, Aida; Akl, Elie A

    To assess the prognostic value of new left bundle branch block (LBBB) in patients with acute myocardial infarction (AMI). LBBB develops in many cardiac conditions, including AMI. The empirical evidence for the contribution of LBBB to mortality in AMI is not consistent. Medline, PubMed, CINAHL, and EMBASE were searched. Inverse variance meta-analysis was performed with odds ratios as the effect estimates. The I 2 statistic and risk of bias were assessed. Eight studies involving 105,861 participants were eligible. New LBBB was associated with higher mortality at 30 days (OR: 2.10, 95% CI 1.27 to 3.48) and 1-year follow up (OR: 2.81, 95% CI 1.64 to 4.80), and increased heart failure risk (OR: 2.64, 95% CI 1.84 to 3.77). AMI patients with new LBBB are a high risk group and must be treated accordingly. Yet, more research is needed given the limitations of studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Comparison of Incidence of Left Ventricular Systolic Dysfunction Among Patients With Left Bundle Branch Block Versus Those With Normal QRS Duration.

    Science.gov (United States)

    Sze, Edward; Dunning, Allison; Loring, Zak; Atwater, Brett D; Chiswell, Karen; Daubert, James P; Kisslo, Joseph A; Mark, Daniel B; Velazquez, Eric J; Samad, Zainab

    2017-12-01

    We compared the incidence of left ventricular systolic dysfunction (LVSD) among patients with left bundle branch block (LBBB) to a matched cohort of patients with a narrow QRS duration <120 ms (NQRS). We hypothesized patients with preserved ejection fraction (EF) ≥50% and LBBB would have higher incidence of LVSD compared with a matched population of NQRS patients. Patients with LBBB on electrocardiogram within 30 days of a baseline echocardiogram with EF ≥50%, who had at least 1 follow-up echocardiogram ≥6 months later, were matched 1:1 on risk factors for cardiomyopathy to patients with NQRS. Incident LVSD was defined as a decline in EF to ≤45% on follow-up echocardiogram, or heart transplant, receipt of a cardiac device for LVSD (defibrillator or biventricular pacemaker), or implantation of a left ventricular assist device ≥6 months post baseline echocardiogram. Relative risk was calculated using conditional Poisson regression techniques. The final study cohort consisted of 188 patients, 94 with LBBB and 94 with NQRS. On follow-up, progression to LVSD was noted in 36% of LBBB patients and 10% of NQRS patients. The relative risk for LVSD in patients with LBBB was 3.78 (95% confidence interval = 1.98 to 7.19). In conclusion, there is a strong association between LBBB and the subsequent development of LVSD independent of common risk factors for cardiomyopathy. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Specificity for each of the 46 criteria of the Selvester QRS score for electrocardiographic myocardial scar sizing in left bundle branch block.

    Science.gov (United States)

    Åkerlund, Sofia; Wieslander, Björn; Turesson, Madeleine; Nijveldt, Robin; Klem, Igor; Almer, Jakob; Engblom, Henrik; Wagner, Galen S; Atwater, Brett D; Ugander, Martin

    2015-01-01

    The Selvester QRS score consists of a set of electrocardiographic criteria designed to identify, quantify and localize scar in the left ventricle using the morphology of the QRS complex. These criteria were updated in 2009 to expand their use to patients with underlying conduction abnormalities, but these versions have thus far only been validated in small and carefully selected populations. To determine the specificity for each of the criteria of the left bundle branch block (LBBB) modified Selvester QRS Score (LB-SS) in a population with strict LBBB and no myocardial scar as verified by cardiovascular magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). We identified ninety-nine patients with LBBB without scar on CMR-LGE, who underwent a clinically indicated CMR scan at three different centers. The ECG recording date was any time prior to or <30days after the CMR scan. The LB-SS was applied and specificity for detection of scar in each of the 46 separate criteria was determined. The specificity ranged between 41% and 100% for the 46 criteria of LB-SS and 27/46 (59%) met ≥95% specificity. The mean±SD specificity was 90%±14%. Several of the criteria in the LB-SS lack adequate specificity. Elimination or modification of these nonspecific QRS morphology criteria may improve the specificity of the overall LB-SS. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. The Prognostic Impact of New-Onset Persistent Left Bundle Branch Block Following Transcatheter Aortic Valve Implantation: A Meta-analysis.

    Science.gov (United States)

    Ando, Tomo; Takagi, Hisato

    2016-09-01

    New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common conduction disturbances after transcatheter aortic valve implantation (TAVI). We hypothesized that NOP-LBBB may have a clinically negative impact after TAVI. To find out, we conducted a systematic literature search of the MEDLINE/PubMed and Embase databases. Observational studies that reported clinical outcomes of NOP-LBBB patients after TAVI were included. The random-effects model was used to combine odds ratios, risk ratios, or hazard ratios (HRs) with 95% confidence intervals. Adjusted HRs were utilized over unadjusted HRs or risk ratios when available. A total of 4049 patients (807 and 3242 patients with and without NOP-LBBB, respectively) were included. Perioperative (in-hospital or 30-day) and midterm all-cause mortality and midterm cardiovascular mortality were comparable between the groups. The NOP-LBBB patients experienced a higher rate of permanent pacemaker implantation (HR: 2.09, 95% confidence interval: 1.12-3.90, P = 0.021, I(2) = 83%) during midterm follow-up. We found that NOP-LBBB after TAVI resulted in higher permanent pacemaker implantation but did not negatively affect the midterm prognosis. Therefore, careful observation during the follow-up is required. © 2016 Wiley Periodicals, Inc.

  11. New-onset left bundle branch block-associated idiopathic nonischemic cardiomyopathy and left ventricular ejection fraction response to guideline-directed therapies: The NEOLITH study.

    Science.gov (United States)

    Wang, Norman C; Singh, Madhurmeet; Adelstein, Evan C; Jain, Sandeep K; Mendenhall, G Stuart; Shalaby, Alaa A; Voigt, Andrew H; Saba, Samir

    2016-04-01

    Left ventricular ejection fraction (LVEF) response to guideline-directed medical therapy (GDMT) and to early cardiac resynchronization therapy (CRT) in new-onset idiopathic nonischemic cardiomyopathy (NICM) and left bundle branch block (LBBB) is not well described. CRT is recommended if LVEF remains ≤35% after at least 3 months of GDMT. The purpose of this study was to describe LVEF response to GDMT at 3 months and to early CRT in new-onset LBBB-associated idiopathic NICM. A retrospective cohort study was performed in subjects with new-onset idiopathic NICM, LVEF ≤35%, and LBBB or narrow (35% in 39 narrow QRS complex subjects (56%) and 2 LBBB subjects (6%) (P 35% (relative risk 10.30; 95% confidence interval 2.63-40.27; P = .0008) and absolute difference between post-GDMT LVEF and initial LVEF (β = 16.296; standard error = 2.977; P < .0001) in final multivariable analyses. CRT super-response, defined as post-CRT LVEF ≥50%, was observed in 8 of LBBB subjects (35%) who received CRT. GDMT did not significantly improve LVEF in new-onset LBBB-associated idiopathic NICM at 3 months. Most remained candidates for CRT, and a high percentage were super-responders. Optimal timing for CRT implantation requires further investigation. Copyright © 2016 Heart Rhythm Society. All rights reserved.

  12. Complete left bundle branch block and smaller left atrium are predictors of response to cardiac resynchronization therapy in advanced heart failure.

    Science.gov (United States)

    Imamura, Teruhiko; Kinugawa, Koichiro; Nitta, Daisuke; Komuro, Issei

    2015-01-01

    We previously reported that cardiac resynchronization therapy with defibrillator (CRT-D) is not an appropriate rescue strategy in patients with advanced heart failure (HF), especially those dependent on inotrope infusion, and instead early ventricular assist device (VAD) implantation should be considered. Predictors of response to CRT in such populations, however, remain uncertain. We studied 67 inpatients aged 10% at 6-month follow up. On logistic regression analysis, LA volume index (LAVI) bundle branch block (CLBBB; OR, 6.663; P=0.032) were significant predictors of response to CRT-D among the baseline variables. Patients with both predictors were associated with improvements in LVEF and plasma B-type natriuretic peptide compared with those with none of these predictors during the 6-month follow up period (P<0.05 for both). VAD-free survival rate was significantly higher in the responders compared with the non-responders during the 2-year study period (86% vs. 52%, P=0.044). CLBBB and smaller LAVI are novel predictors of response in patients with advanced HF receiving CRT-D in real-world practice. Such responders may be better candidates for CRT-D and delay of cardiac replacement therapy.

  13. A new experimentally validated formula to calculate the QT interval in the presence of left bundle branch block holds true in the clinical setting.

    Science.gov (United States)

    Bogossian, Harilaos; Frommeyer, Gerrit; Ninios, Ilias; Pechlivanidou, Eleni; Hasan, Fuad; Nguyen, Quy Suu; Mijic, Dejan; Kloppe, Axel; Karosiene, Zana; Margkarian, Artak; Bandorski, Dirk; Schultes, Dominik; Erkapic, Damir; Seyfarth, Melchior; Lemke, Bernd; Eckardt, Lars; Zarse, Markus

    2017-03-01

    The evaluation of the QT interval in the presence of left bundle branch block (LBBB) is associated with the challenge to discriminate native QT interval from the prolongation due to the increase in QRS duration. The newest formula to evaluate QT interval in the presence of LBBB suggests: modified QT during LBBB = measured QT interval minus 50% of LBBB duration. The purpose of this study is therefore to validate the abovementioned formula in the clinical setting. Validation in two separate groups of patients: Patients who alternated between narrow QRS and intermittent LBBB and patients with narrow QRS who developed LBBB after transcatheter aortic valve implantation (TAVI). The acquired mean native QTc intervals and those calculated by the presented formula displayed no significant differences (p > .99 and p > .75). In this study we proved for the first time the validity and applicability of the experimentally acquired formula for the evaluation of the QT interval in the presence of LBBB in a clinical setting. © 2016 Wiley Periodicals, Inc.

  14. Prolonged QRS duration (QRS >/=170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?

    Science.gov (United States)

    Das, M K; Cheriparambil, K; Bedi, A; Kassotis, J; Reddy, C V; Makan, M; Dunbar, C C; Saul, B

    2001-11-01

    Left bundle branch block (LBBB) is commonly associated with structural heart disease and left ventricular dysfunction. We propose that the QRS duration and degree of left-axis deviation (LAD) identify significant left ventricular systolic dysfunction in patients with LBBB. In this prospective study the ejection fraction (EF) of 300 consecutive patients with LBBB was evaluated by echocardiography. The relationship between QRS duration and LAD (axis between -30 degrees and -90 degrees ) and EF were derived. There was no significant difference in age, sex, presence of ischemic or nonischemic cardiomyopathy and valvular heart disease, and EF among the patients with or without LAD. The EF of patients with QRS >/=170 milliseconds with LAD (n = 20) and without LAD (n = 18) was 25% +/- 16% and 23% +/- 13%, respectively (P =.71). The mean EF (24% +/- 10%) of the patients with a QRS duration of >/=170 milliseconds (n = 38) was significantly lower than the mean EF (36% +/- 16%) of the patients with a QRS duration of axis was not significantly correlated with EF and did not have added predictive value. The QRS duration has a significant inverse relationship with EF and prolongation of QRS duration (>/=170 milliseconds) in the presence of LBBB is a marker of significant left ventricular systolic dysfunction. The presence of LAD in LBBB does not signify a further decrease in EF.

  15. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters.

    Science.gov (United States)

    Marterer, Robert; Hongchun, Zeng; Tschauner, Sebastian; Koestenberger, Martin; Sorantin, Erich

    2015-12-01

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, branch bundle block leads to an asynchronous ventricular contraction • In CMR, a delayed right ventricular contraction due to RBBB can be detected • Ignoring RV physiology in RBBB patients leads to underscoring of RV performance.

  16. Different patterns of bundle-branch blocks and the risk of incident heart failure in the Women's Health Initiative (WHI) study.

    Science.gov (United States)

    Zhang, Zhu-ming; Rautaharju, Pentti M; Soliman, Elsayed Z; Manson, Joann E; Martin, Lisa W; Perez, Marco; Vitolins, Mara; Prineas, Ronald J

    2013-07-01

    We evaluated the risk of incident heart failure (HF) associated with bundle-branch blocks (BBBs) in postmenopausal women. Cox's regression was used to evaluate hazard ratios with 95% confidence intervals for HF among 65975 participants of the Women's Health Initiative (WHI) study during an average follow-up of 14 years. BBBs observed in 1676 women at baseline were categorized into left, right, and indetermined-type BBBs (LBBB, RBBB, and intraventricular conduction defect, respectively). Compared with women with no BBB, LBBB, and intraventricular conduction defect were strong predictors of incident HF in multivariable-adjusted risk models (hazard ratio, 3.79; confidence interval, 2.95-4.87 for LBBB and hazard ratio, 3.53; confidence interval, 2.14-5.81 for intraventricular conduction defect). RBBB was not a significant predictor of incident HF in multivariable-adjusted risk model, but the combination of RBBB and left anterior fascicular block was a strong predictor (hazard ratio, 2.96; confidence interval, 1.77-4.93). QRS duration was an independent predictor of incident HF only in LBBB, with more pronounced risk at QRS ≥ 140 ms than at <140 ms. QRS nondipolar voltage (RNDPV) was an independent predictor in both RBBB and LBBB and, in addition, in LBBB, QRS/STT angle and ST J-point depression in aVL were independent predictors. LBBB, intraventricular conduction defect, and RBBB combined with left anterior fascicular block are strong predictors of incident HF in multivariable-adjusted risk models, but RBBB is not a significant predictor. QRS duration ≥ 140 ms may warrant consideration in LBBB as an indication for further diagnostic evaluation for possible therapeutic and preventive action. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.

  17. Impact on Left Ventricular Function and Remodeling and on 1-Year Outcome in Patients With Left Bundle Branch Block After Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Carrabba, Nazario; Valenti, Renato; Migliorini, Angela; Marrani, Marco; Cantini, Giulia; Parodi, Guido; Dovellini, Emilio Vincenzo; Antoniucci, David

    2015-07-01

    Conflicting results have been reported about the prognostic impact of left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate the impact of LBBB after TAVI on left ventricular (LV) function and remodeling and on 1-year outcomes. Of 101 TAVI patients, 9 were excluded. All complications were evaluated according to the Valve Academic Research Consortium 2 definition. Of 92 patients, 34 developed LBBB without more advanced myocardial damage or inflammation biomarkers in comparison with patients without LBBB. The only predictor of new LBBB was larger baseline LV end-diastolic volume. LBBB plus advanced atrioventricular block was strongly correlated with permanent pacemaker implantation (p <0.0001). Patients with LBBB had a higher rate of permanent pacemaker implantation at 30 days (59% vs 19%, p <0.0001) and less recovery of LV systolic function and a trend toward a lower rate of LV reverse remodeling at 1 year. The development of acute kidney injury and the logistic European System for Cardiac Operative Risk Evaluation score were associated with poor outcomes (all-cause mortality and heart failure) (hazard ratio 6.86, 95% confidence interval 2.51 to 18.74, p <0.0001, and hazard ratio 1.04, 95% confidence interval 1.01 to 1.08, p = 0.021, respectively), but not LBBB. In conclusion, after TAVI, 37% of patients developed new LBBB without more advanced myocardial damage or inflammation biomarkers. LBBB was associated with a higher rate of permanent pacemaker implantation, which negatively affected the recovery of LV systolic function. The development of acute kidney injury, rather than LBBB, increases the 1-year risk for mortality and hospitalization for heart failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Cardiac MRI assessment of right ventricular function: impact of right bundle branch block on the evaluation of cardiac performance parameters

    Energy Technology Data Exchange (ETDEWEB)

    Marterer, Robert; Tschauner, Sebastian; Sorantin, Erich [Medical University of Graz, Division of Pediatric Radiology, Department of Radiology, Graz (Austria); Zeng, Hongchun [First Affiliated Hospital of Xinjiang Medical University, Department of Ultrasonography, Urumqi (China); Koestenberger, Martin [Medical University of Graz, Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Graz (Austria)

    2015-12-15

    Right ventricular (RV) function represents a prognostic marker in patients with corrected congenital heart disease. In up to 80 % of these patients, right branch bundle block (RBBB) exists and leads to asynchronous ventricular contraction. The aim of this retrospective study was to evaluate the change of RV performance parameters considering delayed RV end-systolic contraction. RV volumes of 33 patients were assessed twice: 1) not taking account of RBBB (group I), and 2) considering RBBB (group II). According to the RV ejection fraction (EF) for both groups, RV function was classified in different categories (>50 % = normal, 40-50 % = mildly-, 30-40 % = moderately-, <30 % = severely-reduced). The mean time difference between maximal systolic contraction of the septum and RV free wall was 90.7 ms ± 42.6. Consequently, RV end-systolic volume was significantly decreased in group II (p < 0.001). Accordingly, RV stroke volume and RV EF were significantly higher in group II (p < 0.001). There was also a significant change in the assessment of RV function (p < 0.02). RBBB induced delayed RV contraction can be detected at CMR. Ignoring the RV physiology in RBBB patients leads to a statistically significant underscoring of RV performance parameters. (orig.)

  19. The impact of electrocardiographic left ventricular hypertrophy and bundle branch block on the triage and outcome of ED patients with a suspected acute coronary syndrome: a multicenter study.

    Science.gov (United States)

    Pope, J Hector; Ruthazer, Robin; Kontos, Michael C; Beshansky, Joni R; Griffith, John L; Selker, Harry P

    2004-05-01

    We studied the impact on triage and outcome of the presence of left ventricular hypertrophy (LVH) and left/right bundle branch block (LBBB/RBBB) on the initial ED electrocardiogram (ECG) for patients with symptoms suggestive of an acute coronary syndrome (ACS). Secondary analysis of data from a prospective clinical trial of patients with chest pain or other symptoms suggesting ACS in six U.S. hospitals comparing patient demographics, clinical variables, and outcomes was used. Of 5,324 study patients, 3% had ECG-LVH, 3% had LBBB, 3% had RBBB, and 43% had ischemic ST segment or T wave abnormalities. Compared with patients without ST segment or T wave abnormalities, patients with ECG-LVH or BBB were older and were more likely to have a chief complaint of shortness of breath or a history of cardiac or related diseases. Patients with ECG-LVH or BBB had more diagnoses of congestive heart failure (CHF) and ACS compared with patients without these ECG abnormalities and were just as likely to have ACS as their diagnosis compared with patients with ischemic ST segment or T wave abnormalities. Having ECG-LVH or BBB did not alter the true-positive rate for ACS but increased the false-positive rate by almost 50%. Patients with ECG-LVH had approximately 3.5 times the 30-day mortality rate as those without these ECG abnormalities. It appears that for patients with symptoms suggestive of ACS, the presence of ECG-LVH or BBB did not alter the ability of ED clinicians to identify patients with ACS but was associated with a 50% higher false-positive admission rate compared with similar patients without these ECG abnormalities. With a short-term mortality rate 3.5 times that for patients without ECG-LVH, selected patients with ECG-LVH and symptoms suggesting ACS might benefit from hospitalization for further evaluation.

  20. Clinical characteristics and value in early reperfusion therapy for new onset right bundle branch block in patients with acute myocardial infarction

    Science.gov (United States)

    Li, Jingchao; Li, Xiaodong; Dong, Shujuan; Yang, Yapan; Chu, Yingjie

    2018-01-01

    The value of the right bundle branch block (RBBB) in the treatment of acute myocardial infarction remains unclear. Studies on the RBBB may significantly influence the treatment of acute myocardial infarction. A total of 845 patients with acute myocardial infarction who underwent primary coronary angiography at Henan Provincial People's Hospital were analyzed. Higher peak enzyme levels, a higher ratio of Killip ≥II and closer proximal occlusion of infarct-related artery (IRA) were observed in patients with RBBB compared with those without. The ratio of TIMI flow 0/1 of IRA and ratio of received primary percutaneous coronary intervention (PCI) to IRA in the RBBB group were significantly higher compared with those in the left (L) BBB or no BBB groups. The in-hospital major adverse cardiac events (MACE) incidence in the RBBB group was higher compared with that in the no BBB group, but there was no significant difference between the RBBB and LBBB groups. Logistic regression revealed that proximal occlusion and TIMI flow 0/1 of IRA were predictive factors of RBBB. Cox regression analysis identified RBBB [risk ratio (RR), 4.682; P<0.001] and LBBB (RR, 3.687; P<0.001) as independent predictors of in-hospital MACE. The cumulative one-year survival rate in the RBBB group was significantly lower than those in the no BBB group (P<0.05) and the LBBB group (P<0.05). Similar to the guidelines regarding new onset of LBBB, new onset RBBB should be considered as a standard indicator for reperfusion therapy; as RBBB is associated with more severe symptoms, and higher incidents of complete occlusion of IRA and primary PCI treatment compared with LBBB.

  1. Pre-Existing Right Bundle Branch Block Increases Risk for Death After Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve.

    Science.gov (United States)

    Watanabe, Yusuke; Kozuma, Ken; Hioki, Hirofumi; Kawashima, Hideyuki; Nara, Yugo; Kataoka, Akihisa; Nagura, Fukuko; Nakashima, Makoto; Shirai, Shinichi; Tada, Norio; Araki, Motoharu; Takagi, Kensuke; Yamanaka, Futoshi; Yamamoto, Masanori; Hayashida, Kentaro

    2016-11-14

    The aim of this study was to determine the impact of pre-existing right bundle branch block (RBBB) on clinical outcomes after transcatheter aortic valve replacement (TAVR). The impact of pre-existing RBBB on clinical outcomes after TAVR is unknown. Between October 2013 and August 2015, 749 patients undergoing TAVR using the Edwards SAPIEN XT prosthesis were prospectively enrolled in the OCEAN-TAVI (Optimized Transcatheter Valvular Intervention) registry from 8 Japanese centers. Electrocardiograms were obtained at baseline. After the procedure, follow-up outpatient visits or telephone interviews were conducted at 30 days, 6 months, and yearly. A total of 102 patients (13.6%) had pre-existing RBBB. The incidence of new pacemaker implantation was significantly higher in the RBBB group (17.6% vs. 2.9%; p < 0.01). The Kaplan-Meier analysis revealed that cardiovascular survival probability was significantly lower in the RBBB group than the no-RBBB group (log-rank p < 0.01). Patients with RBBB and without pacemakers were at higher risk for cardiovascular mortality in the early phase after discharge, and patients with RBBB and pacemakers had higher cardiovascular mortality at mid-term follow-up (log-rank p = 0.01). A multivariate Cox regression model indicated that pre-existing RBBB (hazard ratio: 2.59; 95% confidence interval: 1.15 to 5.85; p < 0.01) was an independent predictor of cardiovascular mortality. Patients with RBBB demonstrated an increased risk for cardiovascular mortality after TAVR, and patients with RBBB and without pacemakers were at higher risk for cardiac death early after discharge. Patients with prior RBBB should be carefully monitored after undergoing TAVR. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Comparative long-term outcomes after cardiac resynchronization therapy in right ventricular paced patients versus native wide left bundle branch block patients.

    Science.gov (United States)

    Tayal, Bhupendar; Gorcsan, John; Delgado-Montero, Antonia; Goda, Akiko; Ryo, Keiko; Saba, Samir; Risum, Niels; Sogaard, Peter

    2016-02-01

    The current guidelines do not clearly state when we should upgrade a patient with right ventricular pacing (RVP) to cardiac resynchronization therapy (CRT), although the deleterious effect of chronic RVP has been established with recent trials. The aims of this study were to compare the long-term survival after CRT in patients upgraded from RVP with that in patients with left bundle branch block (LBBB) with QRS duration ≥ 150 ms and to compare the mechanical properties associated with CRT response in these groups. Overall, 135 patients with implanted CRT from a single center (85 (63%) with native wide LBBB and 50 (37%) with RVP) were studied prospectively. Baseline left ventricular typical contraction pattern was determined using speckle tracking echocardiography in the apical 4-chamber view. The predefined end point was death, heart transplantation, or left ventricular assist device implantation over a period of 4 years. Patients with RVP had a significantly favorable long-term outcomes with adjusted hazard ratio of 0.36 (95% confidence interval 0.14-0.96; P = .04). Both groups had ~70% of patients with typical contraction pattern. The absence of typical contraction pattern was associated with a higher risk of an end point with adjusted hazard ratio of 5.43 (95% confidence interval 2.31-12.72; P < .001). In patients with typical contraction pattern, activation of the apical septal segment occurred more frequently in the RVP group and of the base or mid septal segments in the LBBB group. Patients with HF upgraded from RVP have more favorable long-term outcomes after CRT than do native LBBB patients with QRS duration ≥ 150 ms. Contraction pattern assessment can be used to identify potential responders in the RVP group. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  3. New or presumably new left bundle branch block in patients with suspected acute coronary syndrome: Clinical, echocardiographic, and electrocardiographic features from a single-center registry.

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    Hanna, Elias B; Lathia, Viral N; Ali, Murtuza; Deschamps, Eliana Hanna

    2015-01-01

    In patients with suspected acute coronary syndrome, a new or presumably new left bundle branch block (LBBB) does not always imply ST-segment elevation myocardial infarction (STEMI). We aimed to show the low frequency of STEMI-equivalent in this population and determine the diagnostic value of electrocardiographic and echocardiographic features. From the 387 patients captured by the Louisiana State University code STEMI registry between 2009 and 2012, we examined data on 26 patients with LBBB. These patients were divided into 3 groups according to the final diagnosis: (1) STEMI-equivalent, defined as an acute coronary occlusion on angiography (2 patients), (2) non-ST-segment elevation myocardial infarction (4 patients), and (3) diagnoses other than myocardial infarction (non-MI) (20 patients). Troponin elevation and left ventricular systolic dysfunction were common in all 3 groups (non-significant p-values). Compared with non-MI patients, patients with STEMI-equivalent had a larger degree of ST-segment discordance and T-wave discordance, as assessed by ST/QRS and T/QRS ratios (p<0.001). ST/QRS ratio ≥ 0.2 and T/QRS ratio ≥ 0.5 were sensitive and specific for the diagnosis of STEMI-equivalent in the setting of LBBB. Conversely, absolute values of ST-segment and T-wave discordance were not significantly different between groups. ST-segment concordance was highly specific for the diagnosis of STEMI-equivalent, but had a limited sensitivity. Only a minority of patients with suspected acute coronary syndrome and LBBB have a STEMI-equivalent. Excessive relative discordance of the ST segment or the T wave appears predictive of STEMI-equivalent, but this is only hypothesis-generating considering the small population size. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Among patients with left bundle branch block, T-wave peak to T-wave end time is prolonged in the presence of acute coronary occlusion.

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    Dodd, Kenneth W; Elm, Kendra D; Dodd, Erin M; Smith, Stephen W

    2017-06-01

    Assessing the effect of myocardial ischemia on ventricular repolarization in the setting of left bundle branch block (LBBB) poses a challenge due to secondary prolongation of the QT interval inherent in LBBB. The T-wave peak to T-wave end (TpTe) interval has been noted to prolong during myocardial ischemia and correct after reperfusion in patients with normal conduction. Here we compare the TpTe intervals of patients with LBBB both with and without complete acute coronary occlusion (ACO). Retrospectively, emergency department patients with LBBB and symptoms of myocardial ischemia were identified both with angiographically-proven ACO and with No-ACO. The longest QT, JT, and TpTe intervals were analyzed. The ACO and No-ACO groups consisted of 33 and 129 patients, respectively. The mean TpTe was longer in ACO (103.6ms [95%CI 98.5-108.7]) compared to No-ACO patients (88.6ms [95%CI 85.3-91.9]) (P<0.0001) and this held true after correction for heart rate. In ACO versus No-ACO, the TpTe also more frequently exceeded prolongation cutoffs of 85ms (30 [90%] versus 69 [54%]) and 100ms (25 [76%] versus 42 [33%]) (P<0.0001 for all). The mean QT, JT, QTc, and JTc intervals were not significantly different between the groups for either the Bazett's or Rautaharju's correction formulas. In patients with LBBB on the ECG, the TpTe is longer and more frequently prolonged in patients with ACO compared to patients without ACO. Future studies of ventricular repolarization in patients with LBBB should include analyses of the TpTe interval. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Mechanical discoordination increases continuously after the onset of left bundle branch block despite constant electrical dyssynchrony in a computational model of cardiac electromechanics and growth

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    Kerckhoffs, Roy C.P.; Omens, Jeffrey H.; McCulloch, Andrew D.

    2012-01-01

    Aims To test whether a functional growth law leads to asymmetric hypertrophy and associated changes in global and regional cardiac function when integrated with a computational model of left bundle branch block (LBBB). Methods and results In recent studies, we proposed that cardiac myocytes grow longer when a threshold of maximum fibre strain is exceeded and grow thicker when the smallest maximum principal strain in the cellular cross-sectional plane exceeds a threshold. A non-linear cardiovascular model of the beating canine ventricles was combined with the cellular growth law. After inducing LBBB, the ventricles were allowed to adapt in shape over time in response to mechanical stimuli. When subjected to electrical dyssynchrony, the combined model of ventricular electromechanics, haemodynamics, and growth led to asymmetric hypertrophy with a faster increase of wall mass in the left ventricular (LV) free wall (FW) than the septum, increased LV end-diastolic and end-systolic volumes, and decreased LV ejection fraction. Systolic LV pressure decreased during the acute phase of LBBB and increased at later stages. The relative changes of these parameters were similar to those obtained experimentally. Most of the dilation was due to radial and axial fibre growth, and hence altered shape of the LVFW. Conclusion Our previously proposed growth law reproduced measured dyssynchronously induced asymmetric hypertrophy and the associated functional changes, when combined with a computational model of the LBBB heart. The onset of LBBB leads to a step increase in LV mechanical discoordination that continues to increase as the heart remodels despite the constant electrical dyssynchrony. PMID:23104917

  6. Prognostic usefulness of contemporary stress echocardiography in patients with left bundle branch block and impact of contrast use in improving prediction of outcome.

    Science.gov (United States)

    Vamvakidou, Anastasia; Karogiannis, Nikos; Tzalamouras, Vasilis; Parsons, Guy; Young, Grace; Gurunathan, Sothinathan; Senior, Roxy

    2017-04-01

    Patients with symptomatic left bundle branch block (LBBB) may have myocardial ischaemia due to both coronary artery disease and/or cardiomyopathy (microcirculatory abnormalities) and may have concomitant left ventricular (LV) dysfunction. We aimed to assess the feasibility and prognostic value of contemporary stress echocardiography (SE), which can uncover both pathophysiologies in LBBB patients in routine clinical practice, and also aimed to assess the additive value of contrast SE. Accordingly, 190 consecutive patients (age 70.5 ± 11.3 years, LV ejection fraction = 50.1 ± 10%) with symptomatic LBBB who underwent SE over 6 years were assessed, of which 142 (75%) underwent contrast SE and 176 (92.6%) had diagnostic SE. Inducible ischaemia was present in 25 (14.2%) patients. During follow-up (35.4 ± 20.2 months) there were 32 deaths (18%) and 18 (10.2%) first cardiovascular (CV) events (acute myocardial infarction/mortality) in the 176 patients with diagnostic studies. Wall thickening score index at peak stress (WTSIpeak), which measures combined LV function and inducible ischaemia, was an independent predictor of mortality (HR = 3.78, 95% CI = 1.39-10.31, P = 0.01) and CV events (HR = 3.96, 95% CI = 1.1-14.3, P = 0.036). An abnormal SE (myocardial ischaemia and/or abnormal LV function) predicted an almost three-fold increase in all-cause mortality and CV events compared with normal SE. Amongst the confounders affecting assessment of wall thickening in LBBB and conventional prognostic variables, use of contrast was an independent predictor (P = 0.034) of WTSI1.16 (optimal predictor of mortality/CV outcome). SE in patients with LBBB demonstrated high feasibility and the combination of LV systolic function and myocardial ischaemia provided important prognostic information. Contrast-enhanced SE improved the prediction of outcome.

  7. Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation.

    Science.gov (United States)

    Del Greco, Maurizio; Zorzi, Alessandro; Di Matteo, Irene; Cima, Anna; Maines, Massimiliano; Angheben, Carlo; Catanzariti, Domenico

    2017-02-01

    Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT). The purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB). We enrolled 60 patients who underwent electroanatomic mapping system-guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%). Forty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2-4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108-150 ms] vs 100 ms [103-110 ms]; P branches showing LVED >50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB. Patients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  8. Septal and Anterior Reverse Mismatch of Myocardial Perfusion and Metabolism in Patients With Coronary Artery Disease and Left Bundle Branch Block

    Science.gov (United States)

    Wang, Jian-Guang; Fang, Wei; Yang, Min-Fu; Tian, Yue-Qin; Zhang, Xiao-Li; Shen, Rui; Sun, Xiao-Xin; Guo, Feng; Wang, Dao-Yu; He, Zuo-Xiang

    2015-01-01

    Abstract The effects of left bundle branch block (LBBB) on left ventricular myocardial metabolism have not been well investigated. This study evaluated these effects in patients with coronary artery disease (CAD). Sixty-five CAD patients with complete LBBB (mean age, 61.8 ± 9.7 years) and 65 without LBBB (mean age, 59.9 ± 8.4 years) underwent single photon emission computed tomography, positron emission tomography, and contrast coronary angiography. The relationship between myocardial perfusion and metabolism and reverse mismatch score, and that between QRS length and reverse mismatch score and wall motion score were evaluated. The incidence of left ventricular septum and anterior wall reverse mismatching between the two groups was significantly different (P < 0.001 and P = 0.002, respectively). The incidences of normal myocardial perfusion and metabolism in the left ventricular lateral and inferior walls were also significantly different between the two groups (P < 0.001 and P < 0.001, respectively). The incidence of septal reverse mismatching in patients with mild to moderate perfusion was significantly higher among those with LBBB than among those without LBBB (P < 0.001). In CAD patients with LBBB, septal reverse mismatching was significantly more common among those with mild to moderate perfusion than among those with severe perfusion defects (P = 0.002). The correlation between the septal reverse mismatch score and QRS length was significant (P = 0.026). In patients with CAD and LBBB, septal and anterior reverse mismatching of myocardial perfusion and metabolism was frequently present; the septal reverse mismatch score negatively correlated with the QRS interval. PMID:25997045

  9. Genetic variation at the human connexin 43 locus but not at the connexin 40 locus is associated with left bundle branch block

    Science.gov (United States)

    Ladenvall, Per; Andersson, Björn; Dellborg, Mikael; Hansson, Per-Olof; Eriksson, Henry; Thelle, Dag; Eriksson, Peter

    2015-01-01

    Background Bundle branch block (BBB) has been regarded as a disease of the conduction system, but occurs in mice lacking connexin 40 (expressed in atria, proximal conduction system) or connexin 43 (expressed in Purkinje cells, cardiomyocytes). Objective The aim of this paper is to explore whether BBB is heritable, and whether polymorphisms at connexin 40 and connexin 43 loci are associated with BBB. Methods To assess BBB heritability, we screened descendants of men with BBB in the population cohort ‘The Study of Men Born 1913’. DNA samples from 80-year-old men with extreme QRS-duration phenotypes were used to search for polymorphisms at connexin 40 and 43 loci. Associations between identified polymorphisms and BBB were evaluated in an independent cohort (INTERGENE). Results Seventy-seven men from ‘The Study of Men Born 1913’ with BBB had 116 descendants. Among the 76 participating descendants, 2 sons (6.4%) had BBB at 54 years of age. At the same age, 0.9% of men born in 1913 had BBB. We identified 6 single nucleotide polymorphisms (SNPs) in connexin 40 and 1 polymorphism in connexin 43. In the INTERGENE cohort, the connexin 43 polymorphism was associated with left BBB (LBBB) (4 of 35 LBBB vs 16 of 232 without BBB, χ2=7.4, p=0.03), but not with right BBB (RBBB) or overall BBB. None of the connexin 40 SNPs or haplotypes were associated with LBBB or RBBB. Conclusions These findings indicate that conduction by connexin 43 within the ventricular muscle distal to the specialised conduction system may be important for LBBB development. PMID:25893100

  10. A U-shaped type II contraction pattern in patients with strict left bundle branch block predicts super-response to cardiac resynchronization therapy.

    Science.gov (United States)

    Jackson, Tom; Sohal, Manav; Chen, Zhong; Child, Nicholas; Sammut, Eva; Behar, Jonathan; Claridge, Simon; Carr-White, Gerald; Razavi, Reza; Rinaldi, Christopher Aldo

    2014-10-01

    New criteria to define strict left bundle branch block (LBBB) on the basis of pathophysiological principles predict response to cardiac resynchronization therapy (CRT). Heterogeneous activation and contraction patterns have been identified in patients with classical LBBB. Cardiac magnetic resonance (CMR) imaging has demonstrated that a U-shaped (type II) contraction predicts reverse remodeling post-CRT. A homogeneous spread of (type I) contraction is less predictive. The purpose of this study was to investigate contraction patterns among patients with strict LBBB and to test whether a type II contraction pattern better predicts CRT response and super-response. Thirty-seven patients with strict LBBB (QRS duration ≥140 ms for men and ≥130 ms for women with mid-QRS notching or slurring in ≥2 contiguous leads) underwent cine CMR imaging pre-CRT with an analysis of their contraction patterns by using endocardial contour tracking software. Patients were evaluated for reverse remodeling 6 months postimplantation. Nineteen patients (51%) had a type II contraction pattern. A total of 25 patients (68%) of the cohort reverse remodeled. In the type II contraction group, all 19 patients (100%) reverse remodeled as compared with 6 patients (33%) in the type I contraction group (P < .01). Super-response was achieved in 21 patients (57%) of the total cohort: 5 patients with a type I contraction pattern (28%) and 16 patients with a type II contraction pattern (84%) (P < .01). Patients with strict LBBB who are guideline indicated for CRT have heterogeneous contraction patterns derived from cine CMR. A type II contraction pattern is strongly predictive for reverse remodeling and super-response. This questions whether strict LBBB criteria alone are sufficient to reliably predict a positive response to CRT. Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy.

    Science.gov (United States)

    Eschalier, Romain; Ploux, Sylvain; Lumens, Joost; Whinnett, Zachary; Varma, Niraj; Meillet, Valentin; Ritter, Philippe; Jaïs, Pierre; Haïssaguerre, Michel; Bordachar, Pierre

    2015-01-01

    Left bundle branch block (LBBB) leads to prolonged left ventricular (LV) total activation time (TAT) and ventricular electrical uncoupling (VEU; mean LV activation time minus mean right ventricular [RV] activation time); both have been shown to be preferential targets for cardiac resynchronization therapy (CRT). Whether right ventricular apical pacing (RVAP) produces similar ventricular activation patterns has not been well studied. The purpose of this study was to compare electrical ventricular activation patterns during RVAP and LBBB. We performed ECG mapping during sinus rhythm, RVAP, and CRT in 24 patients with LBBB. We observed differences in the electrical activation pattern with RVAP compared to LBBB. During LBBB, RV activation occurred rapidly; in contrast, RV activation was prolonged during RVAP (46 ± 21 ms vs 69 ± 17 ms, P <.001). There was no significant difference in LVTAT; however, differences in conduction pattern were observed. During LBBB, LV activation was circumferential, whereas with RVAP, LV activation proceeded from apex to base. Differences in the number, size, and orientation of lines of slow conduction also were observed. With LBBB, VEU was nearly twice as long as during RVAP (73 ± 12 ms vs 38 ± 21 ms, P <.001). CRT resulted in a greater reduction in VEU relative to LBBB activation (P <.001). RVAP produces significant differences in ventricular activation characteristics compared to LBBB. Significantly less VEU occurs with RVAP, and as a result CRT produces a smaller relative reduction in VEU. This may explain the finding that CRT appears to be more effective in patients with LBBB than in those who were upgraded because of high percentages of RV pacing. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  12. Accuracy of non-invasive techniques for diagnosis of coronary artery disease and prediction of cardiac events in patients with left bundle branch block: a meta-analysis

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    Biagini, Elena [Thoraxcenter Erasmus MC, Department of Cardiology, Rotterdam (Netherlands); University of Bologna, Institute of Cardiology, S.Orsola-Malpighi Hospital, Bologna (Italy); Shaw, Leslee J. [Cedars-Sinai Medical Center, Los Angeles, CA (United States); Poldermans, Don; Schinkel, Arend F.L.; Rizzello, Vittoria [Thoraxcenter Erasmus MC, Department of Cardiology, Rotterdam (Netherlands); Elhendy, Abdou [University of Nebraska Medical Center, Omaha, NE (United States); Rapezzi, Claudio [University of Bologna, Institute of Cardiology, S.Orsola-Malpighi Hospital, Bologna (Italy); Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands)

    2006-12-15

    Non-invasive evaluation of coronary artery disease (CAD) in patients with left bundle branch block (LBBB) has limitations inherent to different tests, and the relative merits of these tests are unclear. This meta-analysis assessed the accuracy of the frequently used non-invasive techniques, including exercise electrocardiography (ECG), myocardial perfusion imaging (MPI) and stress echocardiography (SE), for detection of CAD and prediction of cardiac events in patients with LBBB. A review was conducted of all reports on detection of CAD and prediction of cardiac events in patients with LBBB (published between January 1970 and December 2004), and revealed 55 diagnostic and nine prognostic reports with sufficient details to calculate test accuracy. Weighted (by sample size) sensitivity and specificity were calculated. Summary relative risk ratios (95% confidence intervals) were calculated. Overall sensitivity was higher for exercise ECG and (quantitatively analysed) MPI than for SE (83.4% and 88.5% versus 74.6% respectively, p<0.0001). SE had a higher specificity (88.7%) than MPI (41.2%) and exercise ECG (60.1%) (p<0.0001). Based on analysis of eight reports, the relative risk of cardiac death or myocardial infarction in patients with an abnormal SE and MPI was elevated more than sevenfold, but it did not differ by imaging modality (p=0.9). Meta-analysis of non-invasive CAD assessment in LBBB patients revealed that exercise ECG and MPI had the highest sensitivity, while SE had the highest specificity. The prognostic accuracy of MPI and SE appeared similar. (orig.)

  13. Left bundle branch block with acute thrombotic occlusion is associated with increased myocardial jeopardy score and poor clinical outcomes in primary percutaneous coronary intervention activations.

    Science.gov (United States)

    Brown, Adam J; Hoole, Stephen P; McCormick, Liam M; Malone-Lee, Matt; Cacciottolo, Paul J; Schofield, Peter M; West, Nick E J

    2013-06-01

    To assess the utility of left bundle branch block (LBBB) as an activation criterion for primary percutaneous coronary intervention (PPCI). Retrospective observational cohort study. Single UK heart attack centre. Consecutive patients referred for PPCI September 2008-December 2011 (n=2192). Demographic and outcome data were obtained by review of case notes, angiograms and interrogation of local/national databases. Angiographic culprit lesion assessment defined appropriate and inappropriate activations. Patients outcomes were assessed by Major adverse cardiac events (MACE), defined as a composite of mortality and unplanned revascularisation at 1-year. LBBB-activation occurred in 120 patients (5.5%), of whom 21 (17.5%) had acute coronary occlusion angiographically, and were adjudicated appropriately. Compared with appropriate activations for ST segment elevation, appropriate LBBB-activations were older (71.0 ± 9.6 vs 64.2 ± 12.4 years, p=0.01) and more likely to be in cardiogenic shock (19.0% vs 4.3%, pmyocardium at-risk was higher in appropriate LBBB-activations (culprit jeopardy score median 4, IQR 2-6 vs 2, 2-4, p=0.02). Final diagnoses for LBBB-activations were acute coronary syndrome (39.2%), non-acute coronary syndrome cardiac chest pain (33.3%) and non-cardiac chest pain (27.5%). In appropriate LBBB-activations 1-year mortality and MACE were higher (23.8% vs 6.6%, p=0.002 and 28.6% vs 10.5%, p=0.007, respectively). Our data suggests that despite its poor specificity for identifying acute coronary occlusion, LBBB should at the present time remain an activation criterion for PPCI and such patients should continue to be transferred to heart attack centres for assessment and treatment.

  14. Patients with left bundle branch block and left axis deviation show a specific left ventricular asynchrony pattern: Implications for left ventricular lead placement during CRT implantation.

    Science.gov (United States)

    Sciarra, Luigi; Golia, Paolo; Palamà, Zefferino; Scarà, Antonio; De Ruvo, Ermenegildo; Borrelli, Alessio; Martino, Anna Maria; Minati, Monia; Fagagnini, Alessandro; Tota, Claudia; De Luca, Lucia; Grieco, Domenico; Delise, Pietro; Calò, Leonardo

    2017-10-21

    Left bundle branch block (LBBB) and left axis deviation (LAD) patients may have poor response to resynchronization therapy (CRT). We sought to assess if LBBB and LAD patients show a specific pattern of mechanical asynchrony. CRT candidates with non-ischemic cardiomyopathy and LBBB were categorized as having normal QRS axis (within -30° and +90°) or LAD (within -30° and -90°). Patients underwent tissue Doppler imaging (TDI) to measure time interval between onset of QRS complex and peak systolic velocity in ejection period (Q-peak) at basal segments of septal, inferior, lateral and anterior walls, as expression of local timing of mechanical activation. Thirty patients (mean age 70.6years; 19 males) were included. Mean left ventricular ejection fraction was 0.28±0.06. Mean QRS duration was 172.5±13.9ms. Fifteen patients showed LBBB with LAD (QRS duration 173±14; EF 0.27±0.06). The other 15 patients had LBBB with a normal QRS axis (QRS duration 172±14; EF 0.29±0.05). Among patients with LAD, Q-peak interval was significantly longer at the anterior wall in comparison to each other walls (septal 201±46ms, inferior 242±58ms, lateral 267±45ms, anterior 302±50ms; p<0.0001). Conversely, in patients without LAD Q-peak interval was longer at lateral wall, when compared to each other (septal 228±65ms, inferior 250±64ms, lateral 328±98ms, anterior 291±86ms; p<0.0001). Patients with heart failure, presenting LBBB and LAD, show a specific pattern of ventricular asynchrony, with latest activation at anterior wall. This finding could affect target vessel selection during CRT procedures in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Prolongation of QRS duration and axis deviation in the right bundle branch block are not markers for left ventricular systolic dysfunction.

    Science.gov (United States)

    Uyguanco, Eric R; Mirandi, Anthony; Qureshi, Ghazanfar; Lazar, Jason; Chhabra, Amit; Kassotis, John

    2010-01-01

    Right bundle branch block (RBBB) is not commonly associated with structural heart disease and left ventricular (LV) systolic dysfunction. The purpose of the present study was to determine whether the QRS duration and degree of right axis deviation (RAD) or left axis deviation (LAD) in patients with RBBB predicted a subset of patients with significant LV systolic dysfunction. In the present prospective study, 75 of 200 consecutive patients with RBBB had their ejection fraction (EF) evaluated by echocardiography. The relationship among QRS duration, axis and EF was derived. There were no significant differences in sex and EF among the patients with a normal axis, RAD or LAD. The EFs of patients with a normal axis (n=27), RAD (n=15) and LAD (n=33) were 52±15%, 49±14% and 46±17%, respectively (P=0.35). The mean EF (46±16%) of patients with a QRS duration of 150 ms or greater (n=53) was not significantly different from the mean EF (49±18%) of patients with a QRS duration of less than 150 ms (n=22) (P=0.54). For patients with a QRS of 120 ms or greater and less than 150 ms (n=22), QRS of 150 ms or greater and 180 ms or less (n=48), and QRS of greater than 180 ms (n=5), the mean EFs were 49±18%, 47±16% and 44±7%, respectively (P=0.78). There was no significant correlation between QRS duration and EF in all patients (r=0.03, P=0.83), EF and RAD (r=0.38, P=0.16) or EF and LAD (r=0.26, P=0.14). In patients with RBBB, the QRS duration and axis do not have a significant relationship with EF. Furthermore, prolongation of the QRS duration (150 ms or greater) in the presence of RBBB is not a marker of significant LV systolic dysfunction.

  16. Structural Causes of Right Bundle Branch Block—Time for a Closer Look?

    Science.gov (United States)

    Ker, James

    2010-01-01

    Right bundle branch block is an electrocardiographic phenomenon with specific criteria. Currently, two specific forms of right bundle branch block are acknowledged, a proximal and a distal variant. A vast array of pathologies can cause proximal, distal or even combined forms of right bundle branch block. In this study it is suggested that a third type of right bundle branch block exist: one caused by a subaortic muscular tendon in the left ventricle, leading to an increased velocity of conduction in the left ventricle, with a resultant “relative” right bundle branch block. It is concluded that it is necessary (and time) to take a closer look at endoventricular structures in the assessment of structural causes of right bundle branch block. PMID:20386615

  17. Impact of new-onset persistent left bundle branch block on late clinical outcomes in patients undergoing transcatheter aortic valve implantation with a balloon-expandable valve.

    Science.gov (United States)

    Urena, Marina; Webb, John G; Cheema, Asim; Serra, Vicenç; Toggweiler, Stefan; Barbanti, Marco; Cheung, Anson; Ye, Jian; Dumont, Eric; DeLarochellière, Robert; Doyle, Daniel; Al Lawati, Hatim A; Peterson, Marc; Chisholm, Robert; Igual, Albert; Ribeiro, Henrique Barbosa; Nombela-Franco, Luis; Philippon, François; Garcia Del Blanco, Bruno; Rodés-Cabau, Josep

    2014-02-01

    The aim of this study was to determine the impact of new-onset persistent left bundle branch block (NOP-LBBB) on late outcomes after transcatheter aortic valve implantation (TAVI). The impact of NOP-LBBB after TAVI remains controversial. A total of 668 consecutive patients who underwent TAVI with a balloon-expandable valve without pre-existing LBBB or permanent pacemaker implantation (PPI) were included. Electrocardiograms were obtained at baseline, immediately after the procedure, and daily until hospital discharge. Patients were followed at 1, 6, and 12 months and yearly thereafter. New-onset LBBB occurred in 128 patients (19.2%) immediately after TAVI and persisted at hospital discharge in 79 patients (11.8%). At a median follow-up of 13 months (range 3 to 27 months), there were no differences in mortality rate between the NOP-LBBB and no NOP-LBBB groups (27.8% vs. 28.4%; adjusted-hazard ratio: 0.87 [95% confidence interval (CI): 0.55 to 1.37]; p = 0.54). There were no differences between groups regarding cardiovascular mortality (p = 0.82), sudden death (p = 0.87), rehospitalizations for all causes (p = 0.11), or heart failure (p = 0.55). NOP-LBBB was the only factor associated with an increased rate of PPI during the follow-up period (13.9% vs. 3.0%; hazard ratio: 4.29 [95% CI: 2.03 to 9.07], p < 0.001. NOP-LBBB was also associated with a lack of left ventricular ejection fraction improvement and poorer New York Heart Association functional class at follow-up (p < 0.02 for both). NOP-LBBB occurred in ∼1 of 10 patients who had undergone TAVI with a balloon-expandable valve. NOP-LBBB was associated with a higher rate of PPI, a lack of improvement in left ventricular ejection fraction, and a poorer functional status, but did not increase the risk of global or cardiovascular mortality or rehospitalizations at 1-year follow-up. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Quantitative Analysis of Electro-Anatomical Maps: Application to an Experimental Model of Left Bundle Branch Block/Cardiac Resynchronization Therapy

    Science.gov (United States)

    Duchateau, Nicolas; Kostantyn Butakov, Constantine Butakoff; Andreu, David; Fernández-Armenta, Juan; Bijnens, Bart; Berruezo, Antonio; Sitges, Marta; Camara, Oscar

    2017-01-01

    Electro-anatomical maps (EAMs) are commonly acquired in clinical routine for guiding ablation therapies. They provide voltage and activation time information on a 3-D anatomical mesh representation, making them useful for analyzing the electrical activation patterns in specific pathologies. However, the variability between the different acquisitions and anatomies hampers the comparison between different maps. This paper presents two contributions for the analysis of electrical patterns in EAM data from biventricular surfaces of cardiac chambers. The first contribution is an integrated automatic 2-D disk representation (2-D bull’s eye plot) of the left ventricle (LV) and right ventricle (RV) obtained with a quasi-conformal mapping from the 3-D EAM meshes, that allows an analysis of cardiac resynchronization therapy (CRT) lead positioning, interpretation of global (total activation time), and local indices (local activation time (LAT), surrogates of conduction velocity, inter-ventricular, and transmural delays) that characterize changes in the electrical activation pattern. The second contribution is a set of indices derived from the electrical activation: speed maps, computed from LAT values, to study the electrical wave propagation, and histograms of isochrones to analyze regional electrical heterogeneities in the ventricles. We have applied the proposed methods to look for the underlying physiological mechanisms of left bundle branch block (LBBB) and CRT, with the goal of optimizing the therapy by improving CRT response. To better illustrate the benefits of the proposed tools, we created a set of synthetically generated and fully controlled activation patterns, where the proposed representation and indices were validated. Then, the proposed analysis tools are used to analyze EAM data from an experimental swine model of induced LBBB with an implanted CRT device. We have analyzed and compared the electrical activation patterns at baseline, LBBB, and CRT stages in

  19. Idiopathic left ventricular tachycardia with a right bundle branch block morphology and left axis deviation ("Belhassen type"): results of radiofrequency ablation in 18 patients.

    Science.gov (United States)

    Topilski, Ian; Glick, Aharon; Belhassen, Bernard

    2004-04-01

    Idiopathic left ventricular tachycardia with a right bundle branch block configuration and left axis deviation, first described by Belhassen et al., is a rare electrocardiographic-electrophysiologic entity. Radiofrequency catheter ablation has been proposed as a good therapeutic option, but the best criteria for determining the optimal site of ablation are still under debate. To report the clinical features, electrophysiologic characteristics, results of RFA, and long-term outcome in 18 patients with "Belhassen's VT" treated in our laboratory during the last 10 years, stressing the best electrophysiologic criteria for determining the optimal site of ablation. Eighteen consecutive patients with this specific VT underwent RFA in our laboratory during the last 10 years. RFA was acutely successful in 17 patients after one or two procedures (15 and 2 patients, respectively) using 4.1 +/- 2.2 RF pulses. The putative ablation sites were defined by good pace-mapping (3 patients), earliest recorded Purkinje spike prior to the QRS onset during VT or sinus rhythm (6 patients), earliest endocardial activation during VT (1 patient), and diastolic potential preceding the Purkinje spike during VT and/or late diastolic potential in sinus rhythm (7 patients). In the patients with a definite successful ablation, the ratio of successful to unsuccessful radiofrequency pulse delivery to the diastolic potential site was compared to that of other methods. The ratio of successful RFA at the diastolic potential site (5:8) was higher than in the other methods (8:31) and the difference was statistically significant (P = 0.05). Successful ablation sites were more basal when the diastolic potential site was chosen. The results of the present study confirm the high success rate and safety of RFA using conventional techniques in the management of "Belhassen VT," suggesting that this procedure can be used as a first-line therapy. Ablating at a site demonstrating a late diastolic potential is at

  20. Relation of QRS Duration to Clinical Benefit of Cardiac Resynchronization Therapy in Mild Heart Failure Patients Without Left Bundle Branch Block: The Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy Substudy.

    Science.gov (United States)

    Biton, Yitschak; Kutyifa, Valentina; Cygankiewicz, Iwona; Goldenberg, Ilan; Klein, Helmut; McNitt, Scott; Polonsky, Bronislava; Ruwald, Anne Christine; Ruwald, Martin H; Moss, Arthur J; Zareba, Wojciech

    2016-02-01

    There are conflicting data regarding the efficacy of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and without left bundle branch block. We evaluated the long-term clinical outcomes of 537 non-left bundle branch block patients with mild HF enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study by QRS duration or morphology further stratified by PR interval. At 7 years of follow-up, the cumulative probability of HF hospitalization or death was 45% versus 56% among patients randomized to implantable cardioverter-defibrillator and CRT with defibrillator (CRT-D), respectively (P=0.209). Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile QRS duration group (≤ 134 ms) experienced 2.4-fold (P=0.015) increased risk for HF hospitalization or death with CRT-D versus implantable cardioverter-defibrillator only therapy, whereas the effect of CRT-D in patients from the upper quartiles group (QRS>134 ms) was neutral (hazard ratio [HR] =0.97, P=0.86; P value for interaction =0.024). In a second analysis incorporating PR interval, patients with prolonged QRS (>134 ms) and prolonged PR (>230 ms) were protected with CRT-D (HR=0.31, P=0.003), whereas the association was neutral with prolonged QRS (>134 ms) and shorter PR (≤ 230 ms;, HR=1.19, P=0.386; P value for interaction =0.002). The effect was neutral, regardless of morphology, right bundle branch block (HR=1.01, P=0.975), and intraventricular conduction delay (HR=1.31, P=0.172). Overall, patients with mild HF but without left bundle branch block morphology did not derive clinical benefit with CRT-D during long-term follow-up. Relatively shorter QRS was associated with a significantly increased risk with CRT-D relative to implantable cardioverter-defibrillator -only. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110. © 2016

  1. Bundle branch reentry: A rare mechanism of ventricular tachycardia in endomyocardial fibrosis, without ventricular dilation.

    Science.gov (United States)

    Prabhu, Mukund A; Prasad, B V Srinivas; Thajudeen, Anees; Namboodiri, Narayanan

    2016-09-01

    Bundle branch reentry as a mechanism of ventricular tachycardia (VT) in endomyocardial fibrosis (EMF) is not described. A 52-year-old woman with left ventricular (LV) EMF had VT needing cardioversion. She had mitral regurgitation and left bundle branch block, but no LV dilation or heart failure. During electrophysiological study, clinical VT could be easily induced, and it was confirmed to be bundle branch reentrant VT (BBRVT). She was treated with ablation of the right bundle branch. BBRVT can occur in EMF even without cardiac dilatation. Its recognition is important, as radiofrequency ablation can be curative. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  2. Genetics Home Reference: progressive familial heart block

    Science.gov (United States)

    ... in my area? Other Names for This Condition bundle branch block HBBD hereditary bundle branch defect hereditary bundle branch ... defect TeensHealth from Nemours: Arrhythmias Texas Heart Institute: Bundle Branch Block Patient Support and Advocacy Resources (3 links) American ...

  3. Application of prophylactic gel-pads for transcutaneous pacing in patients with complete right bundle-branch block with axis deviation when surgical procedures are performed: 10-year experience from a single Japanese university hospital.

    Science.gov (United States)

    Okamoto, Aki; Inoue, Satoki; Tanaka, Yu; Kawaguchi, Masahiko; Furuya, Hitoshi

    2009-01-01

    This retrospective study aimed to determine whether prophylactic transcutaneous pacing is required for patients with complete right bundle-branch block (CRBBB) and axis deviation (AD), so-called bifascicular block, when surgical procedures are performed under general or local anesthesia. The authors reviewed 34 063 anesthesia cases that took place at Nara Medical University Hospital during a 10-year period (1996-2005). The anesthesia records of all identified patients having CRBBB or bifascicular block were retrospectively reviewed and the incidence of block progression to complete heart block or bradycardia requiring temporary transcutaneous pacing served as the primary endpoint. As a secondary endpoint, the incidence of block progression to complete heart block or bradycardia requiring only medical treatment was checked. Seventy of the 34 063 patients (0.2%) had CRBBB with AD. Only 1 patient with CRBBB with left AD, who underwent on-pump aorto-coronary bypass grafting surgery, developed complete heart block at the resumption of heartbeat. None of the other 69 patients, except for this cardiac case, developed complete heart block during surgery. Based on this analysis of 70 cases, prophylactic gel-pad electrode application in patients with CRBBB and AD does not appear to be necessary during surgical procedures.

  4. Relationship between two-dimensional speckle-tracking septal strain and response to cardiac resynchronization therapy in patients with left ventricular dysfunction and left bundle branch block: a prospective pilot study.

    Science.gov (United States)

    Maréchaux, Sylvestre; Guiot, Aurélie; Castel, Anne Laure; Guyomar, Yves; Semichon, Marc; Delelis, François; Heuls, Sebastien; Ennezat, Pierre-Vladimir; Graux, Pierre; Tribouilloy, Christophe

    2014-05-01

    Previous studies have demonstrated variable patterns of longitudinal septal deformation in patients with left ventricular (LV) dysfunction and left bundle branch block. This prospective single center study was designed to assess the relationship between septal deformation patterns obtained by two-dimensional speckle-tracking echocardiography and response to cardiac resynchronization therapy (CRT). One hundred one patients with New York Heart Association class II to IV heart failure, LV ejection fractions ≤ 35%, and left bundle branch block underwent echocardiography before CRT. Longitudinal two-dimensional speckle-tracking strain analysis in the apical four-chamber view identified three patterns: double-peaked systolic shortening (pattern 1), early pre-ejection shortening peak followed by prominent systolic stretch (pattern 2), and pseudonormal shortening with a late systolic shortening peak and less pronounced end-systolic stretch (pattern 3). CRT response was defined as a relative reduction in LV end-systolic volume of ≥ 15% at 9-month follow-up. CRT super-response was defined as an absolute LV ejection fraction of ≥ 50% associated with a relative reduction in LV end-systolic volume of ≥ 15% and an improvement in New York Heart Association functional class. Cardiac death or hospitalization for heart failure during follow-up was systematically investigated. Ninety-two percent of patients with pattern 1 or 2 were responders to CRT compared with 59% with pattern 3 (P < .0001). Thirty-six percent of patients with pattern 1 were super-responders compared with 15% of those with pattern 2 and 12% of those with pattern 3 (P = .037). The improvement in LV volumes, LV ejection fraction, and global longitudinal strain after CRT was better in patients with pattern 1 or 2 compared with those with pattern 3 (P < .0001 for all). Eighteen-month outcomes were excellent in patients with pattern 1 or 2, with event-free survival of 95 ± 3% compared with 75 ± 7% in patients

  5. A Wide QRS/T Angle in Bundle Branch Blocks is Associated with Increased Risk for Coronary Heart Disease and All-cause Mortality in the Atherosclerosis Risk in Communities (ARIC) Study

    Science.gov (United States)

    Zhang, Zhu-ming; Rautaharju, Pentti M.; Prineas, Ronald J.; Whitsel, Eric A; Tereshchenko, Larisa; Soliman, Elsayed Z.

    2015-01-01

    BACKGROUND — Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. METHODS and RESULTS — Total 15,408 participants (mean age 54 years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HR) with 95% confidence intervals (CI) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-years follow-up, 4,767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median value. In the pooled ICVD/LBBB group, the risk for CHD death was increased 15.9-fold in women and 6.04 fold in men, and for all-cause deaths 3.01-fold in women and 1.84-fold in men. However, the mortality risk in isolated RBBB group was only significant increase in women but not in men. CONCLUSION — A wide spatial QRS/T angle in BBB is associated with increased risk for CHD and all-cause mortality over and above the predictive value for BBB alone. The risk for women is as high as or higher than that in men. PMID:25959262

  6. Dipyridamole stress myocardial perfusion by computed tomography in patients with left bundle branch block; Perfusao miocardica de estresse com dipiridamol por tomografia computadorizada em pacientes com bloqueio de ramo esquerdo

    Energy Technology Data Exchange (ETDEWEB)

    Cabeda, Estevan Vieira; Rochitte, Carlos Eduardo; Nomura, Cesar Higa; Parga, Jose Rodrigues; Avila, Luiz Francisco Rodrigues; Falcao, Andrea Maria Gomes; Soares Junior, Jose [Instituto do Coracao (InCor), Universidade de Sao Paulo (USP), Sao Paulo, SP (Brazil)

    2015-12-15

    Background: Functional tests have limited accuracy for identifying myocardial ischemia in patients with left bundle branch block (LBBB). Objective: To assess the diagnostic accuracy of dipyridamole-stress myocardial computed tomography perfusion (CTP) by 320-detector CT in patients with LBBB using invasive quantitative coronary angiography (QCA) (stenosis ≥ 70%) as reference; to investigate the advantage of adding CTP to coronary computed tomography angiography (CTA) and compare the results with those of single photon emission computed tomography (SPECT) myocardial perfusion scintigraphy. Methods: Thirty patients with LBBB who had undergone SPECT for the investigation of coronary artery disease were referred for stress tomography. Independent examiners performed per-patient and per-coronary territory assessments. All patients gave written informed consent to participate in the study that was approved by the institution's ethics committee. Results: The patients' mean age was 62 ± 10 years. The mean dose of radiation for the tomography protocol was 9.3 ± 4.6 mSv. With regard to CTP, the per-patient values for sensitivity, specificity, positive and negative predictive values, and accuracy were 86%, 81%, 80%, 87%, and 83%, respectively (p = 0.001). The per-territory values were 63%, 86%, 65%, 84%, and 79%, respectively (p < 0.001). In both analyses, the addition of CTP to CTA achieved higher diagnostic accuracy for detecting myocardial ischemia than SPECT (p < 0.001). Conclusion: The use of the stress tomography protocol is feasible and has good diagnostic accuracy for assessing myocardial ischemia in patients with LBBB. (author)

  7. Age, prognostic impact of QRS prolongation and left bundle branch block, and utilization of cardiac resynchronization therapy: findings from 14,713 patients in the Swedish Heart Failure Registry.

    Science.gov (United States)

    Lund, Lars H; Benson, Lina; Ståhlberg, Marcus; Braunschweig, Frieder; Edner, Magnus; Dahlström, Ulf; Linde, Cecilia

    2014-10-01

    Age is not a contraindication to cardiac resynchronization therapy (CRT), but the prevalence and prognostic impact of QRS prolongation with intraventricular conduction delay (IVCD) and left bundle branch block (LBBB), as well as CRT utilization, may differ with age. We tested the hypotheses that in the elderly: (i) IVCD and LBBB are more prevalent, (ii) IVCD and LBBB are more harmful, and (iii) CRT is underutilized. We studied 14 713 patients with ejection fraction ≤39% in the Swedish Heart Failure Registry and divided into age groups ≤65 years, 66-80 years and >80 years. Among 13 782 patients without CRT, IVCD was present in the three age groups in 11% vs. 15% vs. 19% and LBBB was present in 20% vs. 27% vs. 28%, respectively, (P 80 year group. For LBBB vs. narrow QRS it was 1.29 (1.07-1.56, P = 0.009), 1.17 (1.06-1.30, P = 0.002), and 1.10 (0.99-1.22, P = 0.091), respectively. The adjusted P for interaction between age and QRS morphology was 0.664. In the three age groups, CRT was present in 6% vs. 8% vs. 4% and absent but with indication in 23% vs. 32% vs. 37%, respectively (P < 0.001). Both IVCD and LBBB were more common with increasing age and were similarly strong independent predictors of mortality and in all ages. The underutilization of CRT was worse with increasing age. © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

  8. Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB-TAVI Study.

    Science.gov (United States)

    Massoullié, Grégoire; Bordachar, Pierre; Irles, Didier; Caussin, Christophe; Da Costa, Antoine; Defaye, Pascal; Jean, Frédéric; Mechulan, Alexis; Mondoly, Pierre; Souteyrand, Géraud; Pereira, Bruno; Ploux, Sylvain; Eschalier, Romain

    2016-10-26

    Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His-ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV <70 ms) will be implanted with a loop recorder device with remote monitoring of cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and implanted device follow-up will also be performed at 3, 6 and 12 months. The primary objective is to assess the efficacy and safety of a decisional algorithm based on electrophysiological study and remote monitoring of CIEDs in the prediction of high-grade conduction disturbances in patients with LBBB after TAVI. The primary end point is to compare the incidence (rate and time to onset) of high-grade conduction disturbances in patients with LBBB after TAVI between the two groups at 12 months. Given the proportion of high-grade conduction disturbances (20-40%), a sample of 200 subjects will allow a margin of error of 6-7%. The LBBB-TAVI Study has been in an active recruiting phase since September 2015 (21 patients already included). Local ethics committee authorisation was obtained in May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. NCT02482844; Pre-results. Published by the BMJ Publishing Group Limited. For

  9. Prognosis assessment of persistent left bundle branch block after TAVI by an electrophysiological and remote monitoring risk-adapted algorithm: rationale and design of the multicentre LBBB–TAVI Study

    Science.gov (United States)

    Massoullié, Grégoire; Bordachar, Pierre; Irles, Didier; Caussin, Christophe; Da Costa, Antoine; Defaye, Pascal; Jean, Frédéric; Mechulan, Alexis; Mondoly, Pierre; Souteyrand, Géraud; Pereira, Bruno; Ploux, Sylvain; Eschalier, Romain

    2016-01-01

    Introduction Percutaneous aortic valve replacement (transcatheter aortic valve implantation (TAVI)) notably increases the likelihood of the appearance of a complete left bundle branch block (LBBB) by direct lesion of the LBB of His. This block can lead to high-grade atrioventricular conduction disturbances responsible for a poorer prognosis. The management of this complication remains controversial. Method and analysis The screening of LBBB after TAVI persisting for more than 24 hours will be conducted by surface ECG. Stratification will be performed by post-TAVI intracardiac electrophysiological study. Patients at high risk of conduction disturbances (≥70 ms His–ventricle interval (HV) or presence of infra-Hisian block) will be implanted with a pacemaker enabling the recording of disturbance episodes. Those at lower risk (HV <70 ms) will be implanted with a loop recorder device with remote monitoring of cardiovascular implantable electronic devices (CIEDs). Clinical, ECG and implanted device follow-up will also be performed at 3, 6 and 12 months. The primary objective is to assess the efficacy and safety of a decisional algorithm based on electrophysiological study and remote monitoring of CIEDs in the prediction of high-grade conduction disturbances in patients with LBBB after TAVI. The primary end point is to compare the incidence (rate and time to onset) of high-grade conduction disturbances in patients with LBBB after TAVI between the two groups at 12 months. Given the proportion of high-grade conduction disturbances (20–40%), a sample of 200 subjects will allow a margin of error of 6–7%. The LBBB–TAVI Study has been in an active recruiting phase since September 2015 (21 patients already included). Ethics and dissemination Local ethics committee authorisation was obtained in May 2015. We will publish findings from this study in a peer-reviewed scientific journal and present results at national and international conferences. Trial

  10. Impact of New-Onset Left Bundle Branch Block and Periprocedural Permanent Pacemaker Implantation on Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Regueiro, Ander; Abdul-Jawad Altisent, Omar; Del Trigo, María; Campelo-Parada, Francisco; Puri, Rishi; Urena, Marina; Philippon, François; Rodés-Cabau, Josep

    2016-05-01

    Available data on the clinical impact of new-onset left bundle branch block (LBBB) and permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR) remains controversial. We aimed to evaluate the impact of (1) periprocedural new-onset LBBB or PPI post-TAVR on cardiac mortality and all-cause 1-year mortality and (2) new-onset LBBB on the need for PPI at 1-year follow-up. We performed a systematic search from PubMed and EMBASE databases for studies reporting raw data on new-onset LBBB post-TAVR and the need for PPI or mortality at 1-year follow-up, or on 1-year mortality according to the need for periprocedural PPI post-TAVR. Data from 17 studies, including 4756 patients (8 studies) and 7032 patients (11 studies) for the evaluation of the impact of new-onset LBBB and periprocedural PPI post-TAVR were sourced, respectively (with 2 studies used for both outcomes). New-onset LBBB post-TAVR was associated with a higher risk of PPI (risk ratio [RR], 2.18; 95% confidence interval [CI], 1.28-3.70) and cardiac death (RR, 1.39; 95% CI, 1.04-1.86) during follow-up, as well with a tendency toward an increase in all-cause mortality (RR, 1.21; 95% CI, 0.98-1.50). Periprocedural PPI post-TAVR was not associated with any increased risk of all-cause mortality at 1 year (RR, 1.03; 95% CI, 0.9-1.18), yet a tendency toward a protective effect on cardiac death was observed (RR, 0.78; 95% CI, 0.60-1.03). New-onset LBBB post-TAVR is a marker of an increased risk of cardiac death and need for PPI at 1-year follow-up. The need for PPI early post-TAVR did not increase the risk of death. © 2016 American Heart Association, Inc.

  11. Discontinuous conduction in mouse bundle branches is caused by bundle-branch architecture

    NARCIS (Netherlands)

    van Veen, Toon A. B.; van Rijen, Harold V. M.; van Kempen, Marjan J. A.; Miquerol, Lucile; Opthof, Tobias; Gros, Daniel; Vos, Marc A.; Jongsma, Habo J.; de Bakker, Jacques M. T.

    2005-01-01

    Background - Recordings of the electrical activity of mouse bundle branches ( BBs) suggest reduced conduction velocity ( CV) in the midseptal compared with the proximal part of the BB. The present study was performed to elucidate the mechanism responsible for this slowing of conduction. Methods and

  12. Incessant slow bundle branch reentrant ventricular tachycardia in a young patient with left ventricular noncompaction.

    Science.gov (United States)

    Barra, Sérgio; Moreno, Nuno; Providência, Rui; Gonçalves, Helena; Primo, João José

    2013-06-01

    A 15-year-old girl was admitted to the cardiology outpatient clinic due to mild palpitations and documented incessant slow ventricular tachycardia (VT) with left bundle branch block (LBBB) pattern. The baseline electrocardiogram revealed first-degree atrioventricular block and intraventricular conduction defect. Transthoracic echocardiography showed prominent trabeculae and intertrabecular recesses suggesting left ventricular noncompaction (LVNC), which was confirmed by cardiac magnetic resonance imaging. During electrophysiological study, a sustained bundle branch reentrant VT with LBBB pattern and cycle length of 480 ms, similar to the clinical tachycardia, was easily and reproducibly inducible. As there was considerable risk of need for chronic ventricular pacing following right bundle ablation, no ablation was attempted and a cardioverter-defibrillator was implanted. To the best of our knowledge, no case reports of BBR-VT as the first manifestation of LVNC have been published. Furthermore, this is an extremely rare presentation of BBR-VT, which is usually a highly malignant arrhythmia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  13. Bundle-branch reentry ventricular tachycardia after transcatheter aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Adriana de la Rosa Riestra

    2015-09-01

    Full Text Available An 83-year-old male suffering from severe symptomatic aortic valve stenosis received an implant of a biological aortic prosthesis through the femoral artery without complications. Seven days after dischargement he experienced a syncope. The patient was wearing an ECG holter monitor that day, which showed a wide QRS complex tachycardia of 300 beats per minute. The electrophysiological study revealed a bundle-branch reentry ventricular tachycardia as the cause of the syncope. Radio-frequency was applied on the right-bundle branch. Twelve months later, the patient has remained asymptomatic.

  14. The electromechanical substrate for response to cardiac resynchronization therapy in patients with right bundle branch block

    DEFF Research Database (Denmark)

    Atwater, Brett D; Wagner, Galen S; Kisslo, Joseph

    2017-01-01

    BACKGROUND: Some patients with RBBB may respond to cardiac resynchronization therapy (CRT). However, little is known regarding the electromechanical substrate for CRT and whether this is the optimal pacing strategy. METHODS: This was a pilot prospective double crossover randomized controlled clin...

  15. Discordant vs. concordant left bundle branch block: A potential clinical significance.

    Science.gov (United States)

    Khalil, Jalkh; Bernard, Abi Saleh; Maurice, Khoury; Zaheer, Yousef; Marwan, Refaat; Abdallah, Rebeiz; Samir, Alam; Hadi, Skouri

    2016-01-01

    LBBB in heart failure patients has prognostic significance. Subtypes of LBBB (concordant and discordant) have not been considered when considering management. The aim of this study is to explore the clinical difference between the two subtypes. 216 patients with LBBB were included and categorized into concordant (LBBBC) and discordant (LBBBD) groups. Of the 216 patients (age 69.13±11.7; 56% male 44% female), 133 (61.5%) were LBBBD and 83 (38.5%) were LBBBC. LBBBD patients presented with lower LVEF (mean 36% vs 51%; P<0.001), wider QRS (mean 160 ms vs 151 ms; P<0.001), larger LA (mean 45 cm(2) vs 40 cm(2); P<0.001), moderate to severe mitral and tricuspid regurgitation (17% vs 3%; P<0.05, 10% vs 1%; P<0.05 respectively), CKD (41% vs 18%; P<0.001), COPD (4.6% vs 0%; P<0.01), CAD (67% vs 36%; P<0.001), and CABG (39% vs 16%; P<0.001). LBBBD is significantly associated with worse cardiac function and clinical characteristics. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Is regadenoson an appropriate stressor for MPI in patients with left bundle branch block or pacemakers?

    Science.gov (United States)

    Thomas, Gregory S; Kinser, Carissa R; Kristy, Rita; Xu, Jiaqiong; Mahmarian, John J

    2013-12-01

    Patients with LBBB or ventricular pacemaker undergoing MPI are at risk for false positive MPI results in the setting of an elevated heart rate (HR) with exercise or dobutamine stress. The areas of increased apparent ischemia are typically the LAD and septal territories. In a subanalysis of the ADVANCE MPI 1 and 2 studies, perfusion on an initial adenosine and a second MPI study with regadenoson or adenosine was compared by visual and quantitative analysis. Among 2,015 patients, 64 had LBBB and 93 had pacemakers. The hemodynamic response during the second scan was compared in those with and without LBBB and PM. Following regadenoson, peak HR in the LBBB group increased by a mean of 25.4 compared to 15.3 bpm following adenosine (P = .0083). In the pacemaker group HR was blunted, 11.8 and 8.1 following regadenoson and adenosine, respectively (P = .1262). However, the visually assessed summed difference score and the quantitatively assessed extent of ischemia for the LAD and septal territories and the entire LV did not differ between the initial adenosine and subsequent regadenoson scans. The significant increase in HR observed with regadenoson compared to adenosine did not translate into greater perfusion defects in the LAD or septal territories in patients undergoing regadenoson stress.

  17. Validation of an automatic diagnosis of strict left bundle branch block criteria using 12-lead electrocardiograms

    DEFF Research Database (Denmark)

    Xia, Xiaojuan; Ruwald, Anne-Christine; Ruwald, Martin H

    2017-01-01

    developed a series of algorithms to automatically detect and measure parameters required for strict LBBB criteria and proposed a definition of QRS notch detection. The algorithms were developed using training (n = 20) and validation (n = 592) sets consisting of signal-averaged 12-lead ECGs (1,000 Hz...... variability and 32 ECGs for interobserver variability. We assessed the performance of the automated algorithms using manually adjudicated ECGs as references. RESULTS: Overall sensitivity and specificity for detecting strict LBBB were 95% and 86%, respectively. The mean absolute deviation (MAD) of QRS duration...... the automatic method. In addition 95% and 93% agreements for notches and 90% and 88% agreements for slurs were reached for intra- and interobserver. CONCLUSION: The proposed algorithms automatically measure QRS features for the diagnosis of strict LBBB. Our study shows good performance in reference to manual...

  18. Current concepts relating coronary flow, myocardial perfusion and metabolism in left bundle branch block and cardiac resynchronisation therapy.

    Science.gov (United States)

    Claridge, Simon; Chen, Zhong; Jackson, Tom; Sammut, Eva; Sohal, Manav; Behar, Jonathan; Razavi, Reza; Niederer, Steven; Rinaldi, Christopher Aldo

    2015-02-15

    Cardiac resynchronisation therapy (CRT) improves mortality and symptoms in heart failure patients with electromechanically dyssynchronous ventricles. There is a 50% non-response rate and reproducible biomarkers to predict non-response have not been forthcoming. Therefore, there has been increasing interest in the pathophysiological effects of dyssynchrony particularly focusing on coronary flow, myocardial perfusion and metabolism. Studies suggest that dyssynchronous electrical activation effects coronary flow throughout the coronary vasculature from the epicardial arteries to the microvascular bed and that these changes can be corrected by CRT. The effect of both electrical and mechanical dyssynchrony on myocardial perfusion is unclear with some studies suggesting there is a reduction in septal perfusion whilst others propose that there is an increase in lateral perfusion. Better understanding of these effects offers the possibility for better prediction of non-response. CRT appears to improve homogeneity in myocardial perfusion where heterogeneity is described in the initial substrate. Novel approaches to the identification of non-responders via metabolic phenotyping both invasively and non-invasively have been encouraging. There remains a need for further research to clarify the interaction of coronary flow with perfusion and metabolism in patients who undergo CRT. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

  19. Relation of QRS Duration to Clinical Benefit of Cardiac Resynchronization Therapy in Mild Heart Failure Patients Without Left Bundle Branch Block

    DEFF Research Database (Denmark)

    Biton, Yitschak; Kutyifa, Valentina; Cygankiewicz, Iwona

    2016-01-01

    HF enrolled in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) study by QRS duration or morphology further stratified by PR interval. At 7 years of follow-up, the cumulative probability of HF hospitalization or death was 45% versus 56......% among patients randomized to implantable cardioverter-defibrillator and CRT with defibrillator (CRT-D), respectively (P=0.209). Multivariable-adjusted subgroup analysis by QRS duration showed that patients from the lower quartile QRS duration group (≤ 134 ms) experienced 2.4-fold (P=0.015) increased...... risk for HF hospitalization or death with CRT-D versus implantable cardioverter-defibrillator only therapy, whereas the effect of CRT-D in patients from the upper quartiles group (QRS>134 ms) was neutral (hazard ratio [HR] =0.97, P=0.86; P value for interaction =0.024). In a second analysis...

  20. Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block

    NARCIS (Netherlands)

    Leenders, G.E.H.

    2016-01-01

    Conduction disturbances are present in a large number of heart failure patients. In particular left bundle branch block has subsequent deleterious effects on cardiac structure, function, and efficiency. Cardiac resynchronization therapy is a device based therapy that aims to improve cardiac

  1. A computer heart model incorporating anisotropic propagation. II. Simulations of conduction block.

    Science.gov (United States)

    Lorange, M; Gulrajani, R M; Nadeau, R A; Préda, I

    1993-10-01

    This study describes the simulation of the more common types of conduction blocks with a computer model of the heart incorporating anisotropic propagation. The rationale was to test the model as to its ability to simulate these blocks by physiologically justifiable adjustments of the conduction system alone. The complete blocks were generated by simply blocking conduction totally at selected sites in the proximal conduction system, and the incomplete blocks by slowing down the conduction velocity in the proximal system. Also simulated were the left fascicular blocks and the bilateral blocks. All simulated electrocardiograms, vectorcardiograms, body surface potential maps, and epicardial isochrones for these blocks were similar to clinically observed data, with the exception of the left posterior hemiblock, which was slightly atypical. This could be because such blocks are usually accompanied by other cardiac pathologies not included in our simulations. The model also supports van Dam's observation that during left bundle branch block the passage of activation from right to left occurs via slow myocardial activation with no evidence of a local delay due to a septal barrier. Finally, the model suggests that a left bundle branch block with a normal frontal plane QRS axis may simply represent a case of an incomplete left bundle block, whereas one that exhibits a left axis QRS deviation in the frontal plane represents a more severe complete left bundle branch block.

  2. Exercise-induced left septal fascicular block: an expression of severe myocardial ischemia

    Directory of Open Access Journals (Sweden)

    Augusto Hiroshi Uchida

    2006-04-01

    Full Text Available The electrocardiogram (ECG criteria for the left septal fascicular block (LSFB are not universally accepted and many other denominations can be seen in literature: focal septal block, septal focal block, left septal fascicular block, left anterior septal block, septal fascicular conduction disorder of the left branch, left septal Purkinje network block, left septal subdivision block of the left bundle branch, anterior conduction delay, left median hemiblock, left medial subdivision block of the left bundle branch, middle fascicle block, block of the anteromedial division of the left bundle branch of His, and anteromedial divisional block. During exercise stress test, fascicular blocks (left anterior and posterior seem to indicate severe coronary artery narrowing of left main coronary or proximal left anterior descending artery disease1 and transient exercise-induced left septal fascicular block has been reported a few times2,3. 54-year-old male, with a history of essential arterial systemic hypertension, primary hyperlipidemia and six-month typical chest pain during exercise (Class II – Canadian Cardiovascular Society underwent an exercise stress test. During the exercise stress test, ECG demonstrated abrupt prominent anterior forces, an increase in R wave amplitude from V1 to V4, extreme left axis deviation and minor ST segment depression in DII, DIII and aVF (Figure 1. The post-exercise period showed progressive return of the QRS axis in both frontal and horizontal planes and the ST depression worsened by 1 mm. Coronary angiogram (Figure 2A showed a critical proximal left anterior descending artery lesion. An exercise stress test done three months after coronary artery bypass surgery grafting was normal (Figure 2B.

  3. Complete heart block and asystole following blunt cardiac trauma

    Directory of Open Access Journals (Sweden)

    Mohamed Morsy

    2015-10-01

    Full Text Available Cardiac contusion is a well-recognized complication of blunt chest trauma. Various conduction system disorders have been reported in association with this condition, the most common being right bundle branch block. Complete heart block (CHB is seen rarely. Most cases of CHB are transient. We present the case of an 80-year-old woman who developed CHB and asystole following blunt cardiac trauma. Malignant cardiac arrhythmias such as CHB can be associated with blunt cardiac trauma. In most cases, CHB is transient resolving in days to weeks. In rare cases, however, CHB leads to asystole. Close monitoring and prompt intervention is thus required.

  4. Ablação de taquicardia ventricular idiopática com morfologia de bloqueio de ramo esquerdo localizada no tronco da artéria pulmonar Ablation of idiopathic ventricular tachycardia with left bundle-branch block morphology located in the pulmonary trunk

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Leite

    2005-02-01

    Full Text Available Paciente de 26 anos, sem cardiopatia estrutural, apresentando palpitações e pré-síncopes devido à taquicardia ventricular não sustentada, foi submetida a estudo eletrofisiológico para tentativa de ablação do foco arritmogênico, usando-se como local, os critérios de mapeamento. Sem obter êxito com o mapeamento da via de saída do ventrículo direito, posicionou-se o cateter dentro da artéria pulmonar com mapeamento de foco satisfatório, eliminando a taquicardia tão logo iniciada a radiofreqüência. Durante seguimento de 14 meses, a paciente permanece assintomática, sem arritmia ao Holter e não nessecitando de drogas antiarrítmicas.We report the case of a 26-year-old female patient with palpitations and presyncopes due to nonsustained ventricular tachycardia, who had no structural heart disease. The patient underwent electrophysiological study in an attempt to ablate the arrhythmogenic focus, whose location was determined by using mapping criteria. Because mapping of the right ventricular outflow tract was not successful, the catheter was placed inside the pulmonary artery with satisfactory mapping of the arrhythmogenic focus, and tachycardia was eliminated as soon as radiofrequency was initiated. The patient has remained asymptomatic for 14 months, with no treatment with antiarrhythmic drugs, and no arrhythmias on serial 24-hour Holter.

  5. Myocardial infarction, symptomatic third degree atrioventricular block and pulmonary embolism caused by thalidomide: a case report.

    Science.gov (United States)

    Zhang, Shengyu; Yang, Jing; Jin, Xiaofeng; Zhang, Shuyang

    2015-12-18

    Thalidomide has been reported to cause numerous thromboembolic events. Deep vein thrombosis and pulmonary embolism are more common. It can also cause bradycardia and even total atrioventricular block. Rarely, it causes coronary artery spasm and even myocardial infarction. But almost simultaneous onset of myocardial infarction, third degree atrioventricular block and pulmonary embolism in one patient has not been reported so far. A 53-year old man presented because of chest pain, nausea and then syncope for several minutes. Previous medical history included neurodermitis for which thalidomide was given and hypercholesterolemia with simvastatin taking. The patient didn't exhibit any other established risk factors for coronary artery disease. Electrocardiography showed sinus rhythm with third degree atrioventricular block and complete right bundle branch block, and precordial leads ST segment elevation. The diagnosis of acute coronary syndrome was suspected, but further coronary angiography demonstrated no flow-limiting lesions in coronary arteries, and temporary pacemaker was implanted. After admission, low SpO2 and elevated D-dimer level was mentioned. Further computed tomography pulmonary angiography revealed pulmonary embolism. Thalidomide was thought to be the cause of hypercoagulability and coronary spasm, so it was ceased immediately. Therapeutic low molecule weight heparin was initiated and then switched to warfarin with appropriate INR, and nifedipine was described for coronary spasm. The patient's symptoms completely relived and SpO2 recovered, and atrioventricular block had disappeared during hospitalization with pacemaker removed. This is the very first case in which myocardial infarction, third degree atrioventricular block and pulmonary embolism almost simultaneously developed. We should be ware that anti-thrombotic prophylaxis, which needs further investigation for optimal drug and dosage, may be beneficial in thalidomide therapy. And it is also

  6. SHERLOCK 3CG™ Diamond Tip Confirmation System

    Science.gov (United States)

    2018-02-06

    Indication for Peripheral Intravenous Catheterization; Atrial Flutter; Premature Atrial Contraction; Premature Ventricular Contraction; Premature Junctional Contraction; Tachycardia; Atrioventricular Block; Bundle-Branch Block

  7. 29 CFR Appendix A to Subpart T to... - Examples of Conditions Which May Restrict or Limit Exposure to Hyperbaric Conditions

    Science.gov (United States)

    2010-07-01

    ...., pathological heart block, valvular disease, intraventricular conduction defects other than isolated right bundle branch block, angina pectoris, arrhythmia, coronary artery disease). Juxta-articular osteonecrosis. ...

  8. Transient receptor potential melastatin 4 cation channel in pediatric heart block.

    Science.gov (United States)

    Tian, J; An, X-J; Fu, M-Y

    2017-10-01

    Progressive cardiac conduction disease (PCCD) is a common pediatric heart conduction disorder. It is an autosomal inheritance of rare mutations, which leads to familial cases of PCCD. In these cases, the His-Purkinje system's conductive capacity is progressively deranged, involving either right or left bundle branch block. Also, QRS complexes display widening is an important characteristic that culminates in complete AV block, syncope, and sudden death. Mutations in TRPM4 gene that encodes for transient receptor potential melastatin 4 have recently been reported to cause familial cases of PCCD and heart block. TRPM4 conducts a Ca2+-activated non-selective monovalent cationic current leading to a negative plasma membrane potential. TRPM4 channels let Na+ ion influx, causing membrane depolarization, whereas, at positive membrane potentials, TRPM4 channels repolarize the membrane by facilitating K+ ion efflux from the cell. TRPM4 protein contains many regulatory motifs that confer voltage dependence, ATP/ADP sensitivity, and Ca2+ responsiveness. Mutational studies revealed the significance of the two-calmodulin binding sites at the N-terminus of for Ca2+ dependent activation of this channel. Mutations that reduce deSUMOylation increase the steady-state levels of active TRPM4 channels on the membrane without alteration of its sensitivity to Ca2+ or ATP or its voltage dependence of activation. Increased TRPM4 function interferes with cardiac conduction and eventually contributes to heart block. Both gain and loss of function mutations of TRPM4 are implicated in the cardiac block. Currently, the major therapeutic management of cardiac block due to TRPM4 mutations is implantation of a pacemaker to reinstate normal current propagation through AV node.

  9. Population Blocks.

    Science.gov (United States)

    Smith, Martin H.

    1992-01-01

    Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…

  10. Esclerosis sistémica complicada con síncope y bloqueo AV completo Systemic sclerosis complicated with syncope and complete AV block

    Directory of Open Access Journals (Sweden)

    Francisco Femenía

    2010-10-01

    Full Text Available La esclerosis sistémica es una compleja enfermedad que afecta el tejido conectivo, el sistema vascular y el sistema inmunológico, y se caracteriza por fibrosis cutánea y de órganos viscerales. Los bloqueos de rama y los hemibloqueos se presentan en el 25 a 75% de los casos y constituyen predictores independientes de mortalidad. Los bloqueos auriculoventriculares de segundo o tercer grado son muy raros. Presentamos el caso de una mujer de 47 años de edad, con diagnóstico de esclerosis sistémica, quien presenta episodio sincopal secundario a bloqueo auriculoventricular completo con necesidad de implante de marcapasos definitivo.Systemic sclerosis is a complex disease that affects the connective tissue, the vascular system and the immune system. It typically produces skin and organ fibrosis. Cardiac bundle branch blocks and fascicular blocks occur in 25-75% of the cases and were found to be independent predictors of mortality. Second and third degree atrioventricular block are very rare. We present the case of a 47 year-old female with diagnosis of systemic sclerosis, presented with syncope secondary to complete atrioventricular block requiring permanent pacemaker implantation.

  11. Pathology of complete atrioventricular block in chronic chagas' myocarditis

    Directory of Open Access Journals (Sweden)

    Zilton A. Andrade

    1988-03-01

    Full Text Available Sclero-atrophy, fibrosis, vascular ectasia, phlebosclerosis and mild non-specific chronic inflammatory changes were observed in variable location and proportion involving the atrioventricular conducting tissue of the heart in five human cases of chronic Chagas' myocarditis associated with complete atrioventricular block. One case presented complete destruction of the A-V conduction system. In three cases the lesions were disseminated all along the conducting tissue but did not cause anywhere a complete disruption in the continuity of the system. The distal portion of the bundle branches were the most damaged sector of the system, exceptfor the fasciculi of the posterior division of the left bundle branch which were relatively preserved. One case exhibited bilateral sclero-atrophy of the bundle branches as the main change; and another showed early and mild fibrocalcific damage of the penetrating portion of the His bundle. The A-V node appeared as the least involved part of the conducting system in the cases studied. Demonstration of the lesions in this series of cases seems important because: a it reveals that complete atrioventriculr block in chronic Chagas' disease results from disseminated lesions and not from focal disruptive change as has been commonly observed in cases of other etiologies; b it shows that chronic inflammation can produce at the end variable and widespread vascular, degenerative andfibrotic alterations within the conducting tissue of the heart, which may lead to its total destruction.O estudo do sistema de condução atrioventricular através cortes seriados completos em cinco casos humanos de miocardite crônica chagásica e bloqueio A-V total revelou a presença de lesões de esclero-atrofia, fibrose, ectasia vascular, fleboesclerose e inflamação crônica inespeclfica envolvendo o sistema de maneira disseminada, mas com distribuição e intensidade variáveis de caso para caso. Em um caso, todo o sistema, do nódulo A

  12. Heart block

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/007658.htm Heart block To use the sharing features on this page, ... Date 4/16/2017 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of ...

  13. [Automatic, implantible cardioverter-defibrillator in a patient with chronic Chagas cardiopathy and sustained ventricular tachycardia].

    Science.gov (United States)

    Rodríguez, H; Muñoz, M; Llamas, G; Iturralde, P; Medeiros, A; Delgado, L; Mar, R; Rucinque, F; Bayram, E

    1998-01-01

    We studied a 48 years old woman, with chronic Chagasic cardiopathy, manifested with cardiomegaly, heart failure and syncope, due to a sustained ventricular tachycardia (SVT) of two different configurations (left bundle branch block and right bundle branch block). During electrophysiological testing, both types of ventricular tachycardia were reproduced. Successful ablation therapy of the right branch of His was performed due to suspicion of the bundle branch reentrant tachycardia, with a left bundle branch block. The patient continued to show SVT episodes, now with right bundle branch block pattern. Cardioverter Defibrillator was implanted. We report this case due to the rare frequency of Chagas' disease, where it could be a cause of heart disease, since the existence of the parasite (trypanosoma cruzi) and its vector (Triatoma) has been identified in some rural and suburban zones in the state of Aguascalientes, Mexico.

  14. Ultrasound guided supraclavicular block.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2013-09-01

    Ultrasound guided regional anaesthesia is becoming increasingly popular. The supraclavicular block has been transformed by ultrasound guidance into a potentially safe superficial block. We reviewed the techniques of performing supraclavicular block with special focus on ultrasound guidance.

  15. Evaluation of a New Cardiac Pacemaker

    Science.gov (United States)

    2013-06-25

    Atrial Fibrillation With 2 or 3° AV or Bifascicular Bundle Branch (BBB) Block; Normal Sinus Rhythm With 2 or 3° AV or BBB Block; Sinus Bradycardia With Infrequent Pauses or Unexplained Syncope With EP Findings

  16. Types of Heart Block

    Science.gov (United States)

    ... defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, ...

  17. What Causes Heart Block?

    Science.gov (United States)

    ... defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, ...

  18. Living with Heart Block

    Science.gov (United States)

    ... defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, ...

  19. Data on association between QRS duration on prehospital ECG and mortality in patients with confirmed STEMI

    DEFF Research Database (Denmark)

    Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian

    2017-01-01

    Data presented in this article relates to the research article entitled “Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI” (Hansen et al., in press) [1]. Data on the prognostic effect of automatically recoded QRS duration on prehospital ECG...... and presence of classic left and right bundle branch block in 1777 consecutive patients with confirmed ST segment elevation AMI is presented. Multivariable analysis, suggested that QRS duration >111 ms, left bundle branch block and right bundle branch block were independent predictors of 30 days all...

  20. The link in Linking

    Science.gov (United States)

    Caldwell, Jane C; Chiale, Pablo A; Gonzalez, Mario D; Baranchuk, Adrian

    2013-01-01

    We present 2 cases of the slow-fast form of AVNRT with initially narrow QRS complexes followed by sudden unexpected transition to persistently wide QRS complexes due to aberrant intraventricular conduction. Introduction of a properly timed extrastimulus in one case and critical oscillations in cycle length due to short-long coupling in the second case set the stage for the initial bundle branch block. However, persistence of the aberrancy pattern once the initial event abated was maintained by the "linking" phenomenon. Delayed, retrograde concealed activation from the contralateral bundle branch perpetuated the initial bundle branch block. PMID:23840106

  1. Generalized Block Failure

    DEFF Research Database (Denmark)

    Jönsson, Jeppe

    2015-01-01

    Block tearing is considered in several codes as a pure block tension or a pure block shear failure mechanism. However in many situations the load acts eccentrically and involves the transfer of a substantial moment in combination with the shear force and perhaps a normal force. A literature study...

  2. Total Spinal Block after Thoracic Paravertebral Block.

    Science.gov (United States)

    Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Erdem, Ali Fuat; Palabıyık, Onur

    2014-02-01

    Thoracic paravertebral block (TPVB) can be performed with or without general anaesthesia for various surgical procedures. TPVB is a popular anaesthetic technique due to its low side effect profile and high analgesic potency. We used 20 mL of 0.5% levobupivacaine for a single injection of unilateral TPVB at the T7 level with neurostimulator in a 63 year old patient with co-morbid disease who underwent cholecystectomy. Following the application patient lost consciousness, and was intubated. Haemodynamic instability was normalised with rapid volume replacement and vasopressors. Anaesthetic drugs were stopped at the end of the surgery and muscle relaxant was antagonised. Return of mucle strenght was shown with neuromuscular block monitoring. Approximately three hours after TPVB, spontaneous breathing started and consciousness returned. A total spinal block is a rare and life-threatening complication. A total spinal block is a complication of spinal anaesthesia, and it can also occur after peripheral blocks. Clinical presentation is characterised by hypotension, bradicardia, apnea, and cardiac arrest. An early diagnosis and appropriate treatment is life saving. In this case report, we want to present total spinal block after TPVB.

  3. T-wave morphology analysis of competitive athletes

    DEFF Research Database (Denmark)

    Hong, L; Andersen, Lars Juel; Graff, Claus

    2015-01-01

    right bundle branch block and early repolarization were documented in 25 %, 20%, 13% and 14% of athletes, respectively. ECG criteria for LV hypertrophy in 12-lead ECG were more common in cyclists (35%) than in soccer players (5%), P

  4. Importance and inter-relationship of tissue Doppler variables for predicting adverse outcomes in high-risk patients: an analysis of 388 diabetic patients referred for coronary angiography

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Gislason, Gunnar H; Møgelvang, Rasmus

    2012-01-01

    patients without significant valve disease, bundle branch block, and atrial fibrillation who underwent coronary angiography. Multivariable Cox's regression analyses were used to establish the association between peak systolic (s'), early diastolic (e'), and late diastolic (a') tissue velocities...

  5. Blocked Randomization with Randomly Selected Block Sizes

    Directory of Open Access Journals (Sweden)

    Jimmy Efird

    2010-12-01

    Full Text Available When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes.

  6. Blocked randomization with randomly selected block sizes.

    Science.gov (United States)

    Efird, Jimmy

    2011-01-01

    When planning a randomized clinical trial, careful consideration must be given to how participants are selected for various arms of a study. Selection and accidental bias may occur when participants are not assigned to study groups with equal probability. A simple random allocation scheme is a process by which each participant has equal likelihood of being assigned to treatment versus referent groups. However, by chance an unequal number of individuals may be assigned to each arm of the study and thus decrease the power to detect statistically significant differences between groups. Block randomization is a commonly used technique in clinical trial design to reduce bias and achieve balance in the allocation of participants to treatment arms, especially when the sample size is small. This method increases the probability that each arm will contain an equal number of individuals by sequencing participant assignments by block. Yet still, the allocation process may be predictable, for example, when the investigator is not blind and the block size is fixed. This paper provides an overview of blocked randomization and illustrates how to avoid selection bias by using random block sizes.

  7. Mortality in type 1 vs. type 2 myocardial infarction

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Gerke, Oke; Saaby, Lotte

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  8. Long-term mortality in patients with ST-elevation vs. non-ST-elevation acute myocardial infarction: a real world clinical scenario

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Saaby, Lotte; Poulsen, Tina Svenstrup

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  9. Prognosis in patients having the diagnosis of myocardial infarction made during admission to a non-cardiology department

    DEFF Research Database (Denmark)

    Thygesen, Kristian; Saaby, Lotte; Poulsen, Tina Svenstrup

    2013-01-01

    Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly.......Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly....

  10. To Block or Not to Block?

    NARCIS (Netherlands)

    A.S. (Arona) Cristina; N.M.G. (Nicole) Tweeboom; E.M. (Ellen) Wesselingh

    2013-01-01

    An investigation into whether or not young people studying in higher education in the Netherlands have modified their download behaviour, in the light of a legal obligation to block The Pirate Bay (TPB) by Dutch Internet Service Providers (ISPs). In the lawsuit, it is argued that a blockade by the

  11. Related Drupal Nodes Block

    NARCIS (Netherlands)

    Van der Vegt, Wim

    2010-01-01

    Related Drupal Nodes Block This module exposes a block that uses Latent Semantic Analysis (Lsa) internally to suggest three nodes that are relevant to the node a user is viewing. This module performs three tasks. 1) It periodically indexes a Drupal site and generates a Lsa Term Document Matrix.

  12. Concrete Block Pavements

    Science.gov (United States)

    1983-03-01

    intersections, bus loading areas, and pedestrian crosswalks. The change in surface texture between conven- tional and block pavements has been successful...blocks polished under traffic within a few weeks, providing a pavement surface with unsatisfactory skid resistance. U. K. Cement and Concrete Association...further problems of this type. Kellersman (1980) reports that although many brick pavements have become polished and slippery under traffic, no concrete

  13. Defining block character

    OpenAIRE

    A E Stamps

    1999-01-01

    In this paper I propose a clear, efficient, and accurate method for determining if a block of contiguous buildings has an overall character. The work is needed because most contemporary design reviews presuppose the existence of visual character, but existing design principles are often too vague to make the required determination. Clarity is achieved by shifting from vague notions to a definite concept for block character: a design feature will be perceived as part of the overall character o...

  14. Block ciphers in UMTS

    OpenAIRE

    Mathisen, Tor-Erik

    2004-01-01

    As we are entering the third generation of mobile technology (3G) the number of services needing security grows larger. To assess if the security provided by 3G is sufficient, we take a closer look at the security mechanisms and their building blocks. Within the 3G security environment the Kasumi block cipher plays an important role in the integrity and confidentiality provided. Thus the security of Kasumi, the integrity mode ($9) and confidentiality mode (f8) is vital. ...

  15. Block Cipher Analysis

    DEFF Research Database (Denmark)

    Miolane, Charlotte Vikkelsø

    (AES).Wedescribe the mostgeneraltypes ofblock cipher cryptanalysis but concentrate on the algebraic attacks. While the algebraic techniques have been successful oncertainstreamcipherstheirapplicationtoblock ciphershasnot shown any significant results so far. This thesis contributes to the field of algebraic attacks on block ciphers...... on small scale variants of AES. In the final part of the thesis we present a new block cipher proposal Present and examine its security against algebraic and differential cryptanalysis in particular....

  16. How Is Heart Block Treated?

    Science.gov (United States)

    ... defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, ...

  17. Effects of Block Scheduling

    Directory of Open Access Journals (Sweden)

    William R. Veal

    1999-09-01

    Full Text Available This study examined the effects of a tri-schedule on the academic achievement of students in a high school. The tri-schedule consists of traditional, 4x4 block, and hybrid schedules running at the same time in the same high school. Effectiveness of the schedules was determined from the state mandated test of basic skills in reading, language, and mathematics. Students who were in a particular schedule their freshman year were tested at the beginning of their sophomore year. A statistical ANCOVA test was performed using the schedule types as independent variables and cognitive skill index and GPA as covariates. For reading and language, there was no statistically significant difference in test results. There was a statistical difference mathematics-computation. Block mathematics is an ideal format for obtaining more credits in mathematics, but the block format does little for mathematics achievement and conceptual understanding. The results have content specific implications for schools, administrations, and school boards who are considering block scheduling adoption.

  18. Ischemic Nerve Block.

    Science.gov (United States)

    Williams, Ian D.

    This experiment investigated the capability for movement and muscle spindle function at successive stages during the development of ischemic nerve block (INB) by pressure cuff. Two male subjects were observed under six randomly ordered conditions. The duration of index finger oscillation to exhaustion, paced at 1.2Hz., was observed on separate…

  19. SUPERFICIAL CERVICAL PLEXUS BLOCK

    Directory of Open Access Journals (Sweden)

    Komang Mega Puspadisari

    2014-01-01

    Full Text Available Superficial cervical plexus block is one of the regional anesthesia in  neck were limited to thesuperficial fascia. Anesthesia is used to relieve pain caused either during or after the surgery iscompleted. This technique can be done by landmark or with ultrasound guiding. The midpointof posterior border of the Sternocleidomastoid was identified and the prosedure done on thatplace or on the level of cartilage cricoid.

  20. E-Block: A Tangible Programming Tool with Graphical Blocks

    Directory of Open Access Journals (Sweden)

    Danli Wang

    2013-01-01

    Full Text Available This paper designs a tangible programming tool, E-Block, for children aged 5 to 9 to experience the preliminary understanding of programming by building blocks. With embedded artificial intelligence, the tool defines the programming blocks with the sensors as the input and enables children to write programs to complete the tasks in the computer. The symbol on the programming block's surface is used to help children understanding the function of each block. The sequence information is transferred to computer by microcomputers and then translated into semantic information. The system applies wireless and infrared technologies and provides user with feedbacks on both screen and programming blocks. Preliminary user studies using observation and user interview methods are shown for E-Block's prototype. The test results prove that E-Block is attractive to children and easy to learn and use. The project also highlights potential advantages of using single chip microcomputer (SCM technology to develop tangible programming tools for children.

  1. Demographic Data - MDC_Block

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — A polygon feature class of Miami-Dade Census 2000 Blocks. Census blocks are areas bounded on all sides by visible and/or invisible features shown on a map prepared...

  2. Habitat Blocks and Wildlife Corridors

    Data.gov (United States)

    Vermont Center for Geographic Information — Habitat blocks are areas of contiguous forest and other natural habitats that are unfragmented by roads, development, or agriculture. Vermonts habitat blocks are...

  3. Porous block nanofiber composite filters

    Energy Technology Data Exchange (ETDEWEB)

    Ginley, David S.; Curtis, Calvin J.; Miedaner, Alexander; Weiss, Alan J.; Paddock, Arnold

    2016-08-09

    Porous block nano-fiber composite (110), a filtration system (10) and methods of using the same are disclosed. An exemplary porous block nano-fiber composite (110) includes a porous block (100) having one or more pores (200). The porous block nano-fiber composite (110) also includes a plurality of inorganic nano-fibers (211) formed within at least one of the pores (200).

  4. Learnable Programming: Blocks and Beyond

    OpenAIRE

    Bau, David; Gray, Jeff; Kelleher, Caitlin; Sheldon, Josh; Turbak, Franklyn

    2017-01-01

    Blocks-based programming has become the lingua franca for introductory coding. Studies have found that experience with blocks-based programming can help beginners learn more traditional text-based languages. We explore how blocks environments improve learnability for novices by 1) favoring recognition over recall, 2) reducing cognitive load, and 3) preventing errors. Increased usability of blocks programming has led to widespread adoption within introductory programming contexts across a rang...

  5. Brainstem Anesthesia after Retrobulbar Block

    African Journals Online (AJOL)

    GB

    2016-11-06

    Nov 6, 2016 ... BACKGROUND: Retro-bulbar anesthesia is one of the most common regional blocks used for intraocular surgeries. Complications associated with regional blocks may be limited to the eye or may be systemic. CASE REPORT: After a retro-bulbar block for glaucoma surgery, a 60-year-old man developed ...

  6. Abdominal wall blocks in adults

    DEFF Research Database (Denmark)

    Neimann, Jens Dupont Børglum; Gögenür, Ismail; Bendtsen, Thomas F.

    2016-01-01

    Purpose of review Abdominal wall blocks in adults have evolved much during the last decade; that is, particularly with the introduction of ultrasound-guided (USG) blocks. This review highlights recent advances of block techniques within this field and proposes directions for future research...

  7. Blocking the Hawking radiation

    DEFF Research Database (Denmark)

    Autzen, M.; Kouvaris, C.

    2014-01-01

    grows after its formation (and eventually destroys the star) instead of evaporating. The fate of the black hole is dictated by the two opposite mechanics, i.e., accretion of nuclear matter from the center of the star and Hawking radiation that tends to decrease the mass of the black hole. We study how...... the assumptions for the accretion rate can in fact affect the critical mass beyond which a black hole always grows. We also study to what extent degenerate nuclear matter can impede Hawking radiation due to the fact that emitted particles can be Pauli blocked at the core of the star....

  8. Program structure-based blocking

    Science.gov (United States)

    Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.; Sura, Zehra N.

    2017-09-26

    Embodiments relate to program structure-based blocking. An aspect includes receiving source code corresponding to a computer program by a compiler of a computer system. Another aspect includes determining a prefetching section in the source code by a marking module of the compiler. Yet another aspect includes performing, by a blocking module of the compiler, blocking of instructions located in the prefetching section into instruction blocks, such that the instruction blocks of the prefetching section only contain instructions that are located in the prefetching section.

  9. Block copolymer investigations

    Science.gov (United States)

    Yufa, Nataliya A.

    The research presented in this thesis deals with various aspects of block copolymers on the nanoscale: their behavior at a range of temperatures, their use as scaffolds, or for creation of chemically striped surfaces, as well as the behavior of metals on block copolymers under the influence of UV light, and the healing behavior of copolymers. Invented around the time of World War II, copolymers have been used for decades due to their macroscopic properties, such as their ability to be molded without vulcanization, and the fact that, unlike rubber, they can be recycled. In recent years, block copolymers (BCPs) have been used for lithography, as scaffolds for nano-objects, to create a magnetic hard drive, as well as in photonic and other applications. In this work we used primarily atomic force microscopy (AFM) and transmission electron microscopy (TEM), described in Chapter II, to conduct our studies. In Chapter III we demonstrate a new and general method for positioning nanoparticles within nanoscale grooves. This technique is suitable for nanodots, nanocrystals, as well as DNA. We use AFM and TEM to demonstrate selective decoration. In Chapters IV and V we use AFM and TEM to study the structure of polymer surfaces coated with metals and self-assembled monolayers. We describe how the surfaces were created, exhibit their structure on the nanoscale, and prove that their macroscopic wetting properties have been altered compared to the original polymer structures. Finally, Chapters VI and VII report out in-situ AFM studies of BCP at high temperatures, made possible only recently with the invention of air-tight high-temperature AFM imaging cells. We locate the transition between disordered films and cylinders during initial ordering. Fluctuations of existing domains leading to domain coarsening are also described, and are shown to be consistent with reptation and curvature minimization. Chapter VII deals with the healing of PS-b-PMMA following AFM-tip lithography or

  10. Celiac ganglia block

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim [Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100 Ankara (Turkey); Akhan, Okan [Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100 Ankara (Turkey)]. E-mail: oakhan@hacettepe.edu.tr

    2005-09-01

    Pain occurs frequently in patients with advanced cancers. Tumors originating from upper abdominal viscera such as pancreas, stomach, duodenum, proximal small bowel, liver and biliary tract and from compressing enlarged lymph nodes can cause severe abdominal pain, which do not respond satisfactorily to medical treatment or radiotherapy. Percutaneous celiac ganglia block (CGB) can be performed with high success and low complication rates under imaging guidance to obtain pain relief in patients with upper abdominal malignancies. A significant relationship between pain relief and degree of tumoral celiac ganglia invasion according to CT features was described in the literature. Performing the procedure in the early grades of celiac ganglia invasion on CT can increase the effectiveness of the CGB, which is contrary to World Health Organization criteria stating that CGB must be performed in patients with advanced stage cancer. CGB may also be effectively performed in patients with chronic pancreatitis for pain palliation.

  11. Photovoltaic building blocks

    DEFF Research Database (Denmark)

    Hanberg, Peter Jesper; Jørgensen, Anders Michael

    2014-01-01

    efficiency of about 15% for commercial Silicon solar cells there is still much to gain. DTU Danchip provides research facilities, equipment and expertise for the building blocks that comprises fabricating the efficient solar cell. In order to get more of the sun light into the device we provide thin film...... coating tools to depositand develop anti-reflection filters by means of sputtering or e-beam evaporation. To reduce the area taken up by metallic contacts transparent conducting oxides like Aluminium doped ZincOxide (AZO) and Indium Tin Oxide (ITO) can be deposited. We also support research.......7%2. Such efforts we also provide service for through our tools designed for this material system.Our team of process generalists can guide and advice you to utilize our clean room facilities most efficiently while our process specialists can help you to develop new processes and fabrication recipes. Our dedicated...

  12. Large Block Test Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Lin, W

    2001-12-01

    This report documents the Large-Block Test (LBT) conducted at Fran Ridge near Yucca Mountain, Nevada. The LBT was a thermal test conducted on an exposed block of middle non-lithophysal Topopah Spring tuff (Tptpmn) and was designed to assist in understanding the thermal-hydrological-mechanical-chemical (THMC) processes associated with heating and then cooling a partially saturated fractured rock mass. The LBT was unique in that it was a large (3 x 3 x 4.5 m) block with top and sides exposed. Because the block was exposed at the surface, boundary conditions on five of the six sides of the block were relatively well known and controlled, making this test both easier to model and easier to monitor. This report presents a detailed description of the test as well as analyses of the data and conclusions drawn from the test. The rock block that was tested during the LBT was exposed by excavation and removal of the surrounding rock. The block was characterized and instrumented, and the sides were sealed and insulated to inhibit moisture and heat loss. Temperature on the top of the block was also controlled. The block was heated for 13 months, during which time temperature, moisture distribution, and deformation were monitored. After the test was completed and the block cooled down, a series of boreholes were drilled, and one of the heater holes was over-cored to collect samples for post-test characterization of mineralogy and mechanical properties. Section 2 provides background on the test. Section 3 lists the test objectives and describes the block site, the site configuration, and measurements made during the test. Section 3 also presents a chronology of events associated with the LBT, characterization of the block, and the pre-heat analyses of the test. Section 4 describes the fracture network contained in the block. Section 5 describes the heating/cooling system used to control the temperature in the block and presents the thermal history of the block during the test

  13. Paraumbilical block for umbilical herniorraphy.

    Science.gov (United States)

    Clarke, Frederick K; Cassey, John G

    2007-08-01

    Umbilical herniorraphy is a common paediatric surgery day case. Paraumbilical blocks have previously been reported to provide excellent analgesia for umbilical hernia repairs. Local anaesthesia through a paraumbilical block was compared with local infiltration. Postoperative analgesic requirements were used to gauge the effectiveness of the techniques. Patients receiving a paraumbilical block required significantly less analgesia postoperatively. These patients were generally discharged from hospital sooner. Paraumbilical block results in improved postoperative pain control through the more precise delivery of local anaesthetic to the intercostal nerves.

  14. Four-block beam collimator

    CERN Multimedia

    CERN PhotoLab

    1977-01-01

    The photo shows a four-block collimator installed on a control table for positioning the alignment reference marks. Designed for use with the secondary beams, the collimators operated in vacuum conditions. The blocks were made of steel and had a standard length of 1 m. The maximum aperture had a square coss-section of 144 cm2. (See Annual Report 1976.)

  15. Block storage subsystem performance analysis

    CERN Multimedia

    CERN. Geneva

    2016-01-01

    You feel that your service is slow because of the storage subsystem? But there are too many abstraction layers between your software and the raw block device for you to debug all this pile... Let's dive on the platters and check out how the block storage sees your I/Os! We can even figure out what those patterns are meaning.

  16. Interscalene block for shoulder surgery

    African Journals Online (AJOL)

    2011-06-15

    Jun 15, 2011 ... comprising 0.25% bupivacaine and 1.0% of lidocaine with 1 : 200 000 epinephrine in equal parts was administered to establish the block. Surgical anesthesia was achieved 18 minutes after instituting the block and surgery lasted 70 minutes without complications. This technique may obviate the use of ...

  17. OPAL Various Lead Glass Blocks

    CERN Multimedia

    These lead glass blocks were part of a CERN detector called OPAL (one of the four experiments at the LEP particle detector). OPAL uses some 12 000 blocks of glass like this to measure particle energies in the electromagnetic calorimeter. This detector measured the energy deposited when electrons and photons were slowed down and stopped.

  18. Region 9 Census Block 2010

    Science.gov (United States)

    Geography:The TIGER Line Files are feature classes and related database files (.) that are an extract of selected geographic and cartographic information from the U.S. Census Bureau's Master Address File / Topologically Integrated Geographic Encoding and Referencing (MAF/TIGER) Database (MTDB). The MTDB represents a seamless national file with no overlaps or gaps between parts, however, each TIGER Line File is designed to stand alone as an independent data set, or they can be combined to cover the entire nation. Census Blocks are statistical areas bounded on all sides by visible features, such as streets, roads, streams, and railroad tracks, and/or by non visible boundaries such as city, town, township, and county limits, and short line-of-sight extensions of streets and roads. Census blocks are relatively small in area; for example, a block in a city bounded by streets. However, census blocks in remote areas are often large and irregular and may even be many square miles in area. A common misunderstanding is that data users think census blocks are used geographically to build all other census geographic areas, rather all other census geographic areas are updated and then used as the primary constraints, along with roads and water features, to delineate the tabulation blocks. As a result, all 2010 Census blocks nest within every other 2010 Census geographic area, so that Census Bureau statistical data can be tabulated at the block level and aggregated up t

  19. The wild tapered block bootstrap

    DEFF Research Database (Denmark)

    Hounyo, Ulrich

    -based method in terms of asymptotic accuracy of variance estimation and distribution approximation. For stationary time series, the asymptotic validity, and the favorable bias properties of the new bootstrap method are shown in two important cases: smooth functions of means, and M-estimators. The first......In this paper, a new resampling procedure, called the wild tapered block bootstrap, is introduced as a means of calculating standard errors of estimators and constructing confidence regions for parameters based on dependent heterogeneous data. The method consists in tapering each overlapping block...... of the series first, the applying the standard wild bootstrap for independent and heteroscedastic distrbuted observations to overlapping tapered blocks in an appropriate way. Its perserves the favorable bias and mean squared error properties of the tapered block bootstrap, which is the state-of-the-art block...

  20. Criminal Justice Systems. Block I: Law Enforcement. Block II: The Courts. Block III: Corrections. Block IV: Community Relations. Block V: Proficiency Skills. Block VI: Criminalistics. Student Guide.

    Science.gov (United States)

    Florida State Dept. of Education, Tallahassee. Div. of Vocational, Adult, and Community Education.

    This student guide together with an instructor guide comprise a set of curriculum materials on the criminal justice system. The student guide contains self-contained instructional material that students can study at their own pace most of the time. Six major subject areas or blocks, which are further broken down into several units, with some units…

  1. Criminal Justice Systems. Block I: Law Enforcement. Block II: The Courts. Block III: Corrections. Block IV: Community Relations. Block V: Proficiency Skills. Block VI: Criminalistics. Instructor Guide.

    Science.gov (United States)

    Florida State Dept. of Education, Tallahassee. Div. of Vocational, Adult, and Community Education.

    This instructor guide together with a student guide comprise a set of curriculum materials on the criminal justice system. The instructor guide is a resource for planning and managing individualized, competency-based instruction in six major subject areas or blocks, which are further broken down into several units with some units having several…

  2. Data on association between QRS duration on prehospital ECG and mortality in patients with confirmed STEMI

    Directory of Open Access Journals (Sweden)

    Rikke Hansen

    2017-12-01

    Full Text Available Data presented in this article relates to the research article entitled “Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI” (Hansen et al., in press [1].Data on the prognostic effect of automatically recoded QRS duration on prehospital ECG and presence of classic left and right bundle branch block in 1777 consecutive patients with confirmed ST segment elevation AMI is presented. Multivariable analysis, suggested that QRS duration >111 ms, left bundle branch block and right bundle branch block were independent predictors of 30 days all-cause mortality. For interpretation and discussion of these data, refer to the research article referenced above.

  3. Conformal Nets II: Conformal Blocks

    Science.gov (United States)

    Bartels, Arthur; Douglas, Christopher L.; Henriques, André

    2017-08-01

    Conformal nets provide a mathematical formalism for conformal field theory. Associated to a conformal net with finite index, we give a construction of the `bundle of conformal blocks', a representation of the mapping class groupoid of closed topological surfaces into the category of finite-dimensional projective Hilbert spaces. We also construct infinite-dimensional spaces of conformal blocks for topological surfaces with smooth boundary. We prove that the conformal blocks satisfy a factorization formula for gluing surfaces along circles, and an analogous formula for gluing surfaces along intervals. We use this interval factorization property to give a new proof of the modularity of the category of representations of a conformal net.

  4. MarineMineralsProgramBlocks

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains OCS block outlines and delineated polygons in ESRI ArcGIS shape file format for the BOEM Gulf of Mexico Region that contain sediment resources...

  5. Recursion Relations for Conformal Blocks

    CERN Document Server

    Penedones, João; Yamazaki, Masahito

    2016-09-12

    In the context of conformal field theories in general space-time dimension, we find all the possible singularities of the conformal blocks as functions of the scaling dimension $\\Delta$ of the exchanged operator. In particular, we argue, using representation theory of parabolic Verma modules, that in odd spacetime dimension the singularities are only simple poles. We discuss how to use this information to write recursion relations that determine the conformal blocks. We first recover the recursion relation introduced in 1307.6856 for conformal blocks of external scalar operators. We then generalize this recursion relation for the conformal blocks associated to the four point function of three scalar and one vector operator. Finally we specialize to the case in which the vector operator is a conserved current.

  6. A Novel Tetrathiafulvalene Building Block

    DEFF Research Database (Denmark)

    Jeppesen, Jan Oskar; Takimiya, Kazuo; Thorup, Niels

    1999-01-01

    Efficient synthesis of a novel tetrathiafulvalene building block. 2,3-bis(2-cyanoethylthio)-6,7-bis(thiocyanato-methyl)tetrathiafulv alene (7) useful for stepwise and asymmetrical bis-function-alization is reported.......Efficient synthesis of a novel tetrathiafulvalene building block. 2,3-bis(2-cyanoethylthio)-6,7-bis(thiocyanato-methyl)tetrathiafulv alene (7) useful for stepwise and asymmetrical bis-function-alization is reported....

  7. Risking Aggression: Reply to Block

    OpenAIRE

    Kris Borer

    2010-01-01

    In his paper, “Is There an ‘Anomalous’ Section of the Laffer Curve?”, Walter Block describes some situations in which it appears that a libertarian should violate the non-aggression principle. To rectify this, Block proposes a different perspective on libertarianism which he calls punishment theory. This paper argues that no new theory is needed, as the non-aggression principle can be used to resolve theapparent conundrums.

  8. Risking Aggression: Reply to Block

    Directory of Open Access Journals (Sweden)

    Kris Borer

    2010-05-01

    Full Text Available In his paper, “Is There an ‘Anomalous’ Section of the Laffer Curve?”, Walter Block describes some situations in which it appears that a libertarian should violate the non-aggression principle. To rectify this, Block proposes a different perspective on libertarianism which he calls punishment theory. This paper argues that no new theory is needed, as the non-aggression principle can be used to resolve theapparent conundrums.

  9. Holomorphic blocks in three dimensions

    Energy Technology Data Exchange (ETDEWEB)

    Beem, Christopher [Simons Center for Geometry and Physics, Stony Brook University,Stony Brook, NY 11794-3636 (United States); Dimofte, Tudor [Institute for Advanced Study,Einstein Dr., Princeton, NJ 08540 (United States); Trinity College,Cambridge CB2 1TQ (United Kingdom); Pasquetti, Sara [Department of Mathematics, University of Surrey,Guildford, Surrey, GU2 7XH (United Kingdom)

    2014-12-30

    We decompose sphere partition functions and indices of three-dimensional N=2 gauge theories into a sum of products involving a universal set of “holomorphic blocks”. The blocks count BPS states and are in one-to-one correspondence with the theory’s massive vacua. We also propose a new, effective technique for calculating the holomorphic blocks, inspired by a reduction to supersymmetric quantum mechanics. The blocks turn out to possess a wealth of surprising properties, such as a Stokes phenomenon that integrates nicely with actions of three-dimensional mirror symmetry. The blocks also have interesting dual interpretations. For theories arising from the compactification of the six-dimensional (2,0) theory on a three-manifold M, the blocks belong to a basis of wavefunctions in analytically continued Chern-Simons theory on M. For theories engineered on branes in Calabi-Yau geometries, the blocks offer a non-perturbative perspective on open topological string partition functions.

  10. Earlier Right Ventricular Pacing in Cardiac Resynchronization Therapy for a Patient with Right Axis Deviation.

    Science.gov (United States)

    Hattori, Yusuke; Ishibashi, Kohei; Noda, Takashi; Okamura, Hideo; Kanzaki, Hideaki; Anzai, Toshihisa; Yasuda, Satoshi; Kusano, Kengo

    2017-09-01

    We describe the case of a 37-year-old woman who presented with complete right bundle branch block and right axis deviation. She was admitted to our hospital due to severe heart failure and was dependent on inotropic agents. Cardiac resynchronization therapy was initiated but did not improve her condition. After the optimization of the pacing timing, we performed earlier right ventricular pacing, which led to an improvement of her heart failure. Earlier right ventricular pacing should be considered in patients with complete right bundle branch block and right axis deviation when cardiac resynchronization therapy is not effective.

  11. Neuromuscular blocking properties of dioxonium.

    Science.gov (United States)

    Tammisto, T; Salmenperä, M

    1980-12-01

    The characteristics of the myoneural block caused by a new neuromuscular blocking agent, dioxonium (Dx), were evaluated in surgical patients. The force and the corresponding electromyogram (EMG) of the thumb adduction evoked by various modes of ulnar nerve stimuli were measured. Onset, maintenance and disappearance of blockade after sequential administration of Dx were compared with results obtained with d-tubocurarine (dTc) or suxamethonium (Sx). Initially the Dx block was shown to be depolarizing with a negligible fade in the 2 Hz train of four stimuli with a single twitch suppression of 90%. On a weight basis, Dx was found to be about 15 times as potent as dTc in suppressing twitch to the 90% level. During maintenance, the block gained nondepolarizing characteristics with profound fades in the 2 and 50 Hz trains. The transition was associated with tachyphylaxis and with a more pronounced suppression of EMG amplitude than that measured in the twitch force. After a total dose of about 100 microgram/kg of Dx, the sensitivity to Dx again increased and the discrepancy between twitch tension and EMG disappeared. This pattern of changes was also seen with Sx. Spontaneous recovery occurred slightly faster than after dTc blocks of corresponding duration. With neostigmine, reversal was hastened and a full recovery with restitution of prerelaxant twitch and disappearance of fades was reached in about 20 min. Some discrepancy in EMG amplitude and twitch force persisted, however.

  12. High prevalence of cardiac involvement in patients with myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Witting, Nanna; Ersbøll, Mads Kristian

    2014-01-01

    , Holter-monitoring and muscle strength testing. RESULTS: Cardiac involvement was found in 71 patients (55%) and included: 1) Conduction abnormalities: atrio-ventricular block grade I (AVB grade I) (23.6%), AVB grade II (5.6%), right/left bundle branch block (5.5/3.2%) and prolonged QTc (7.2%); 2...

  13. Deferred versus conventional stent implantation in patients with ST-segment elevation myocardial infarction (DANAMI 3-DEFER)

    DEFF Research Database (Denmark)

    Kelbæk, Henning; Høfsten, Dan Eik; Køber, Lars

    2016-01-01

    -segment elevation of 0·1 mV or more in at least two or more contiguous electrocardiographic leads or newly developed left bundle branch block. Patients were randomly assigned (1:1), via an electronic web-based system with permuted block sizes of two to six, to receive either standard primary PCI with immediate...

  14. Electrocardiographic Changes In Hypertensive Patients Undergoing ...

    African Journals Online (AJOL)

    It was observed from the electrocardiographic changes in the hypertensive patients that oral surgical procedures caused first-degree atrio-ventricular block and right bundle branch block, which appears not to have been previously reported. Furthermore, this study demonstrates ST segment depression during surgery phase ...

  15. Diversity Gain through Antenna Blocking

    Directory of Open Access Journals (Sweden)

    V. Dehghanian

    2012-01-01

    Full Text Available As part of the typical usage mode, interaction between a handheld receiver antenna and the operator's RF absorbing body and nearby objects is known to generate variability in antenna radiation characteristics through blocking and pattern changes. It is counterintuitive that random variations in blocking can result in diversity gain of practical applicability. This diversity gain is quantified from a theoretical and experimental perspective. Measurements carried out at 1947.5 MHz verify the theoretical predictions, and a diversity gain of 3.1 dB was measured through antenna blocking and based on the utilized measurement setup. The diversity gain can be exploited to enhance signal detectability of handheld receivers based on a single antenna in indoor multipath environments.

  16. OPAL 96 Blocks Lead Glass

    CERN Multimedia

    This array of 96 lead glass bricks formed part of the OPAL electromagnetic calorimeter. One half of the complete calorimeter is shown in the picture above. There were 9440 lead glass counters in the OPAL electromagnetic calorimeter. These are made of Schott type SF57 glass and each block weighs about 25 kg and consists of 76% PbO by weight. Each block has a Hamamatsu R2238 photomultiplier glued on to it. The complete detector was in the form of a cylinder 7m long and 6m in diameter. It was used to measure the energy of electrons and photons produced in LEP interactions.

  17. Who Is at Risk for Heart Block?

    Science.gov (United States)

    ... defects. Acquired heart block is more common than congenital heart block. Damage to the heart muscle or its electrical system causes acquired heart block. Diseases, surgery, or medicines can cause this damage. The three types of heart block are first degree, second degree, ...

  18. Sympathetic blocks for visceral cancer pain management

    DEFF Research Database (Denmark)

    Mercadante, Sebastiano; Klepstad, Pal; Kurita, Geana Paula

    2015-01-01

    The neurolytic blocks of sympathetic pathways, including celiac plexus block (CPB) and superior hypogastric plexus block (SHPB) , have been used for years. The aim of this review was to assess the evidence to support the performance of sympathetic blocks in cancer patients with abdominal visceral...

  19. Main-chain supramolecular block copolymers.

    Science.gov (United States)

    Yang, Si Kyung; Ambade, Ashootosh V; Weck, Marcus

    2011-01-01

    Block copolymers are key building blocks for a variety of applications ranging from electronic devices to drug delivery. The material properties of block copolymers can be tuned and potentially improved by introducing noncovalent interactions in place of covalent linkages between polymeric blocks resulting in the formation of supramolecular block copolymers. Such materials combine the microphase separation behavior inherent to block copolymers with the responsiveness of supramolecular materials thereby affording dynamic and reversible materials. This tutorial review covers recent advances in main-chain supramolecular block copolymers and describes the design principles, synthetic approaches, advantages, and potential applications.

  20. First Degree Pacemaker Exit Block

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2016-10-01

    Full Text Available Usually atrial and ventricular depolarizations follow soon after the pacemaker stimulus (spike on the ECG. But there can be an exit block due to fibrosis at the electrode - tissue interface at the lead tip. This can increase the delay between the spike and atrial or ventricular depolarization.

  1. Vagal Blocking for Obesity Control

    DEFF Research Database (Denmark)

    Johannessen, Helene; Revesz, David; Kodama, Yosuke

    2017-01-01

    BACKGROUND: Recently, the US FDA has approved "vagal blocking therapy or vBLoc® therapy" as a new treatment for obesity. The aim of the present study was to study the mechanism-of-action of "VBLOC" in rat models. METHODS: Rats were implanted with VBLOC, an intra-abdominal electrical device...

  2. Building Blocks for Personal Brands

    Science.gov (United States)

    Thomas, Lisa Carlucci

    2011-01-01

    In this article, the author discusses the four essential building blocks for personal brands: (1) name; (2) message; (3) channels; and (4) bridges. However, outstanding building materials can only take a person so far. The author emphasizes that vision, determination, faith, a sense of humor, and humility are also required.

  3. On the Eigenvalues and Eigenvectors of Block Triangular Preconditioned Block Matrices

    KAUST Repository

    Pestana, Jennifer

    2014-01-01

    Block lower triangular matrices and block upper triangular matrices are popular preconditioners for 2×2 block matrices. In this note we show that a block lower triangular preconditioner gives the same spectrum as a block upper triangular preconditioner and that the eigenvectors of the two preconditioned matrices are related. © 2014 Society for Industrial and Applied Mathematics.

  4. Development of Signal Processing Blocks

    Science.gov (United States)

    James, Xavier; Voinov, Alexey

    2017-09-01

    Experiments executed on the Dubna Gas Filled Recoil Separator (DGFRS) at the Flerov Laboratory of Nuclear Reactions, Joint Institute of Nuclear Research, has proved the hypothesis of the existence of an `island of stability' of super heavy nuclei. It is a highly sensitive detection system that uses the method of ``active correlations'' which allows rare events of the decay of super heavy nuclei to be detected in almost background-free conditions. The role of the signal processing block is to distribute an event signal to the rest of the data acquisition components within the trigger system. In doing so, it will synchronize the rest of the data acquisition signal blocks when an alpha particle recoil appears in the Dubna Gas-Filled Recoil Separator detector. This helps to limit the amount of background interference as the DGFRS undergoes an experiment with a targeted heavy nucleus to receive coherent and succinct results. Joint Institute of Nuclear Research and NSF Grant Number PHY 1713816.

  5. Compact planar microwave blocking filters

    Science.gov (United States)

    U-Yen, Kongpop (Inventor); Wollack, Edward J. (Inventor)

    2012-01-01

    A compact planar microwave blocking filter includes a dielectric substrate and a plurality of filter unit elements disposed on the substrate. The filter unit elements are interconnected in a symmetrical series cascade with filter unit elements being organized in the series based on physical size. In the filter, a first filter unit element of the plurality of filter unit elements includes a low impedance open-ended line configured to reduce the shunt capacitance of the filter.

  6. UAV PHOTOGRAMMETRY: BLOCK TRIANGULATION COMPARISONS

    Directory of Open Access Journals (Sweden)

    R. Gini

    2013-08-01

    Full Text Available UAVs systems represent a flexible technology able to collect a big amount of high resolution information, both for metric and interpretation uses. In the frame of experimental tests carried out at Dept. ICA of Politecnico di Milano to validate vector-sensor systems and to assess metric accuracies of images acquired by UAVs, a block of photos taken by a fixed wing system is triangulated with several software. The test field is a rural area included in an Italian Park ("Parco Adda Nord", useful to study flight and imagery performances on buildings, roads, cultivated and uncultivated vegetation. The UAV SenseFly, equipped with a camera Canon Ixus 220HS, flew autonomously over the area at a height of 130 m yielding a block of 49 images divided in 5 strips. Sixteen pre-signalized Ground Control Points, surveyed in the area through GPS (NRTK survey, allowed the referencing of the block and accuracy analyses. Approximate values for exterior orientation parameters (positions and attitudes were recorded by the flight control system. The block was processed with several software: Erdas-LPS, EyeDEA (Univ. of Parma, Agisoft Photoscan, Pix4UAV, in assisted or automatic way. Results comparisons are given in terms of differences among digital surface models, differences in orientation parameters and accuracies, when available. Moreover, image and ground point coordinates obtained by the various software were independently used as initial values in a comparative adjustment made by scientific in-house software, which can apply constraints to evaluate the effectiveness of different methods of point extraction and accuracies on ground check points.

  7. [THE TECHNOLOGY "CELL BLOCK" IN CYTOLOGICAL PRACTICE].

    Science.gov (United States)

    Volchenko, N N; Borisova, O V; Baranova, I B

    2015-08-01

    The article presents summary information concerning application of "cell block" technology in cytological practice. The possibilities of implementation of various modern techniques (immune cytochemnical analysis. FISH, CISH, polymerase chain reaction) with application of "cell block" method are demonstrated. The original results of study of "cell block" technology made with gelatin, AgarCyto and Shadon Cyoblock set are presented. The diagnostic effectiveness of "cell block" technology and common cytological smear and also immune cytochemical analysis on samples of "cell block" technology and fluid cytology were compared. Actually application of "cell block" technology is necessary for ensuring preservation of cell elements for subsequent immune cytochemical and molecular genetic analysis.

  8. Adductor canal block versus femoral nerve block for analgesia after total knee arthroplasty

    DEFF Research Database (Denmark)

    Jaeger, Pia; Zaric, Dusanka; Fomsgaard, Jonna Storm

    2013-01-01

    Femoral nerve block (FNB), a commonly used postoperative pain treatment after total knee arthroplasty (TKA), reduces quadriceps muscle strength essential for mobilization. In contrast, adductor canal block (ACB) is predominately a sensory nerve block. We hypothesized that ACB preserves quadriceps...

  9. Vector electrocardiographic alterations after percutaneous septal ablation in obstructive hypertrophic cardiomyopathy: possible anatomic causes

    Directory of Open Access Journals (Sweden)

    Pérez Riera Andrés Ricardo

    2002-01-01

    Full Text Available OBJECTIVE: Analyze the dromotropic disturbances (vector-electrocardiographic, and the possible anatomic causes, provoked by selective alcohol injection in the septal branch, for percutaneous treatment, of obstructive hypertrophic cardiomyopathy. METHODS: Ten patients with a mean age of 52.7 years underwent percutaneous septal ablation (PTSA from october 1998; all in functional class III/IV. Twelve-lead electrocardiogram was performed prior to and during PTSA, and later electrocardiogram and vectorcardiogram according to Frank's method. The patients were followed up for 32 months. RESULTS: On electrocardiogram (ECG prior to PTSA all patients had sinus rhythm and left atrial enlargement, 8 left ventricular hypertrophy of systolic pattern. On ECG immediately after PTSA, 8 had complete right bundle-branch block; 1 transient total atrioventricular block; 1 alternating transient bundle-branch block either right or hemiblock. On late ECG 8 had complete right bundle-branch block confirmed by vectorcardiogram, type 1 or Grishman. CONCLUSION: Septal fibrosis following alcohol injection caused a predominance of complete right bundle-branch block, different from surgery of myotomy/myectomy.

  10. Some basic properties of block operator matrices

    OpenAIRE

    Jin, Guohai; Chen, Alatancang

    2014-01-01

    General approach to the multiplication or adjoint operation of $2\\times 2$ block operator matrices with unbounded entries are founded. Furthermore, criteria for self-adjointness of block operator matrices based on their entry operators are established.

  11. Haplotype block structure is conserved across mammals

    NARCIS (Netherlands)

    Guryev, V.; Smits, B.M.; van de Belt, J.; Verheul, M.; Hubner, N.; Cuppen, E.

    2006-01-01

    Genetic variation in genomes is organized in haplotype blocks, and species-specific block structure is defined by differential contribution of population history effects in combination with mutation and recombination events. Haplotype maps characterize the common patterns of linkage disequilibrium

  12. Surgeon Administered Regional Anaesthetic Blocks For Hand ...

    African Journals Online (AJOL)

    Methods: We describe the simple, but effective, perivascular axillary block technique we have used for regional anaesthetic blocks for hand surgery. We also undertook a prospective cohort study of all patients undergoing hand surgery under this regional block technique at Mulago Hospital. We abstracted the drug and ...

  13. Block Coordinate Descent Only Converge to Minimizers

    OpenAIRE

    Song, Enbin; Shen, Zhubin; Shi, Qingjiang

    2017-01-01

    Given a non-convex twice continuously differentiable cost function with Lipschitz continuous gradient, we prove that all of block coordinate gradient descent, block mirror descent and proximal block coordinate descent converge to a local minimizer, almost surely with random initialization. Furthermore, we show that these results also hold true even for the cost functions with non-isolated critical points.

  14. Encoders for block-circulant LDPC codes

    Science.gov (United States)

    Divsalar, Dariush (Inventor); Abbasfar, Aliazam (Inventor); Jones, Christopher R. (Inventor); Dolinar, Samuel J. (Inventor); Thorpe, Jeremy C. (Inventor); Andrews, Kenneth S. (Inventor); Yao, Kung (Inventor)

    2009-01-01

    Methods and apparatus to encode message input symbols in accordance with an accumulate-repeat-accumulate code with repetition three or four are disclosed. Block circulant matrices are used. A first method and apparatus make use of the block-circulant structure of the parity check matrix. A second method and apparatus use block-circulant generator matrices.

  15. 31 CFR 515.319 - Blocked account.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account. 515.319 Section 515... § 515.319 Blocked account. The term blocked account shall mean an account in which any designated national has an interest, with respect to which account payments, transfers or withdrawals or other...

  16. 31 CFR 500.319 - Blocked account.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account. 500.319 Section 500... § 500.319 Blocked account. The term blocked account shall mean an account in which any designated national has an interest, with respect to which account payments, transfers or withdrawals of other...

  17. Programs to Swap Diagonal Blocks,

    Science.gov (United States)

    1987-06-01

    Introduction bi adr 2. The Software c Dist Special 3. General Theory 4. Implementations details 4.1. Stadardized Real Schur Form 42. Solving AIX- XA2 = B 4.3... Software Economizer (EXCENG) Consider a submatrix of the form A 1B 1020 A2 where A1 and A2 are ZxZ diagonal blocks. Algorithm 0 (called EXC-NG in [Ste...s) in 4.4 we need only to compute Cj and C2 using the formulae above. We skip the details of algebric manipulations and give the results below. case

  18. Seismicity of the Jalisco Block

    Science.gov (United States)

    Nunez-Cornu, F. J.; Rutz, M.; Camarena-Garcia, M.; Trejo-Gomez, E.; Reyes-Davila, G.; Suarez-Plascencia, C.

    2002-12-01

    In April 2002 began to transmit the stations of the first phase of Jalisco Telemetric Network located at the northwest of Jalisco Block and at the area of Volcan de Fuego (Colima Volcano), in June were deployed four additional MarsLite portable stations in the Bahia de Banderas area, and by the end of August one more portable station at Ceboruco Volcano. The data of these stations jointly with the data from RESCO (Colima Telemetric Network) give us the minimum seismic stations coverage to initiate in a systematic and permanent way the study of the seismicity in this very complex tectonic region. A preliminary analysis of seismicity based on the events registered by the networks using a shutter algorithm, confirms several important features proposed by microseismicity studies carried out between 1996 and 1998. A high level of seismicity inside and below of Rivera plate is observed, this fact suggest a very complex stress pattern acting on this plate. Shallow seismicity at south and east of Bahia de Banderas also suggest a complex stress pattern in this region of the Jalisco Block, events at more than 30 km depth are located under the mouth of the bay and in face of it, a feature denominated Banderas Boundary mark the change of the seismic regime at north of this latitude (20.75°N), however some shallow events were located at the region of Nayarit.

  19. Randomized Block Cubic Newton Method

    KAUST Repository

    Doikov, Nikita

    2018-02-12

    We study the problem of minimizing the sum of three convex functions: a differentiable, twice-differentiable and a non-smooth term in a high dimensional setting. To this effect we propose and analyze a randomized block cubic Newton (RBCN) method, which in each iteration builds a model of the objective function formed as the sum of the natural models of its three components: a linear model with a quadratic regularizer for the differentiable term, a quadratic model with a cubic regularizer for the twice differentiable term, and perfect (proximal) model for the nonsmooth term. Our method in each iteration minimizes the model over a random subset of blocks of the search variable. RBCN is the first algorithm with these properties, generalizing several existing methods, matching the best known bounds in all special cases. We establish ${\\\\cal O}(1/\\\\epsilon)$, ${\\\\cal O}(1/\\\\sqrt{\\\\epsilon})$ and ${\\\\cal O}(\\\\log (1/\\\\epsilon))$ rates under different assumptions on the component functions. Lastly, we show numerically that our method outperforms the state-of-the-art on a variety of machine learning problems, including cubically regularized least-squares, logistic regression with constraints, and Poisson regression.

  20. Disease: H00728 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available enetic disorder that is characterised by abnormal electrocardiogram (ECG) findings and an increased risk of sudden... segment elevation and sudden cardiac death: a distinct clinical and electrocardi...ase Report Med 2010:823490 (2010) PMID:1309182 Brugada P, Brugada J Right bundle branch block, persistent ST

  1. Pathoaetiology, Pathophysiology and Clinical Management

    African Journals Online (AJOL)

    RICHY

    There may be other features of heart disease such as left ventricular hypertrophy, bundle-branch block, acute or prior MI. Echocardiography is an important test to perform to evaluate for structural and functional lesions. This is more important in countries like Zambia where RHD valvular lesions are a common cause of AF.

  2. Transvenous biventricular pacing in a child after congenital heart surgery as an alternative therapy for congestive heart failure

    NARCIS (Netherlands)

    Blom, Nico A.; Bax, Jeroen J.; Ottenkamp, Jaap; Schalij, Martin J.

    2003-01-01

    Transvenous Biventricular Pacing in Children. Cardiac resynchronization therapy improves short-term and long-term hemodynamics in adult patients with congestive heart failure and left bundle branch block. We describe the feasibility of transvenous biventricular pacemaker implantation in a 6-year-old

  3. Fragmented QRS Electrocardiogram- The Hidden Talisman?

    Directory of Open Access Journals (Sweden)

    Frijo Jose

    2009-09-01

    Full Text Available There are several stigmas on the resting surface electrocardiogram that are indicators of past myocardial injury. Broad QRS pattern with bundle branch block, Q waves, persistent ST elevation are some of those facsimiles which may at times even be considered as definitive signs of left ventricular impairment.

  4. Snoring and atherosclerotic manifestations in a 70-year-old population

    DEFF Research Database (Denmark)

    Jennum, P; Schultz-Larsen, K; Christensen, N J

    1996-01-01

    ) into positive ECG signs (Q/OS waves, S-T depressions, T-wave inversion or flattering or left bundle branch block) and definitive myocardial infarction. Snoring showed a weak positive correlation to positive ECG signs and definitive myocardial infarction, but after adjustments for the above confounders...

  5. QT interval prolongation in patients with hypertensive heart disease ...

    African Journals Online (AJOL)

    Prolonged QTc was defined as QTc > 440 ms in males and > 460 ms in females, or more than 500ms in both sexes in the presence of complete bundle branch block. A p-value of <0.05 was considered statistically significant. Results: A total of 113 patients were recruited consecutively, and 32 of them (28.3%) had prolonged ...

  6. Long-term prognostic importance of hyperkinesia following acute myocardial infarction. TRACE Study Group. TRAndolapril Cardiac Evaluation

    DEFF Research Database (Denmark)

    Kjøller, E; Køber, L; Jørgensen, S

    1999-01-01

    , angina, or diabetes, previous AMI, age, thrombolytic therapy, arrhythmias, and bundle branch block. In a multivariate analysis including nonhyperkinetic-WMI, hyperkinesia was associated with a relative risk of 0.84, which was statistically significant (confidence intervals 0.74 to 0.96; p = 0.01). When...

  7. CASE REPORT Arrythmogenic right ventricular dysplasia ...

    African Journals Online (AJOL)

    RBBB: right bundle-branch block. RV: right ventricular. RVEDV: right ventricular end diastolic volume. RVEF: right ventricular ejection fraction. RVOT: right ventricular outflow tract. SAECG: signal averaged electrocardiogram. VT: ventricular tachycardia. 'Modifications of the orginal criteria have been proposed to facilitate ...

  8. 275 THE AETIOLOGY AND POSSmLE PREVENTION OF ...

    African Journals Online (AJOL)

    1971-03-13

    Mar 13, 1971 ... The criteria used for diag- nosis were the clinical history and examination with ECG evidence of pathological Q waves, S-T segment changes, later T-wave inversion, a faIling R wave in the precordial leads, complete left bundle-branch block and, where necessary, significant and transient elevation of serum.

  9. Arrhythmia classification using SVM with selected features | Kohli ...

    African Journals Online (AJOL)

    The various types of arrhythmias in the cardiac arrhythmias ECG database chosen from University of California at Irvine (UCI) to train SVM include ischemic changes (coronary artery disease), old inferior myocardial infarction, sinus bradycardy, right bundle branch block, and others. ECG arrhythmia datasets are of generally ...

  10. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial

    DEFF Research Database (Denmark)

    Gervais, Renaud; Leclercq, Christophe; Shankar, Aparna

    2009-01-01

    , urgent transplantation, or cardiovascular hospitalization. Among patients assigned to CRT, 39% had unfavourable outcomes including 55 deaths. By single variable analysis, (i) prolonged PR interval, left QRS axis (but not QRS duration), and left bundle branch block (BBB) at baseline, and (ii) heart rate...

  11. Evaluation of Cardiovascular Morbidity in Nigerian Women after 3 ...

    African Journals Online (AJOL)

    elearning

    affecting the bundle of His and the Purkinje network. This situation is referred to as bundle branch block. Apart from a small proportion of subjects in whom it may pass for normal, ischaemic heart disease and myocardial infarction. Figure 1: Weight Changes in Nigerian. Women after 36 Months of Norplant Use. 58. 60. 62. 64.

  12. Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)

    DEFF Research Database (Denmark)

    Lee, Andy Y; Moss, Arthur J; Ruwald, Martin H

    2015-01-01

    and effects on subsequent outcomes and benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Multivariate Cox models were used to determine the temporal influence of previous HF hospitalization on the end point of HF or death within all left bundle branch block implantable cardioverter...

  13. Dyspnea in the ambulance - etiology, mortality, and point-of-care diagnostics

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann

    2016-01-01

    in the ambulance. Electrocardiographic assessment leading to suspicion of ST-elevation myocardial infarction or bundle branch block myocardial infarction was useful for identification of a small group of patients with very high risk of death, emphasizing the importance of obtaining an electrocardiogram in patients...

  14. Simple regional strain pattern analysis to predict response to cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Risum, Niels; Jons, Christian; Olsen, Niels T

    2012-01-01

    A classical strain pattern of early contraction in one wall and prestretching of the opposing wall followed by late contraction has previously been associated with left bundle branch block (LBBB) activation and short-term response to cardiac resynchronization therapy (CRT). Aims of this study were...

  15. Case report

    African Journals Online (AJOL)

    abp

    2012-07-03

    Jul 3, 2012 ... heart failure was made. The electrocardiography detected sinus tachycardia of 104 beats per minutes, right axis deviation, an incomplete right bundle-branch block and no conduction disturbances. A chest X ray was normal. Ascites and hepatic congestion were revealed by an abdominal ultra- sonogram.

  16. Development of chronic heart failure in a young woman with hypertension associated with renal artery stenosis with preserved renal function

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat

    2014-01-01

    A 33-year-old woman with presumed essential hypertension and symptoms equivalent to New York Heart Association class II was suspected of heart failure and referred to echocardiography. The patient's ECG showed a left bundle branch block. Electrolytes, serum creatinine and estimated...

  17. Left ventricular structure and function in black normotensive type 2 ...

    African Journals Online (AJOL)

    More diabetic patients had left atrial enlargement (LAE) and left bundle branch block (LBBB) than controls (P=0.006 and 0.006 respectively). Abnormalities of ST segment and. Q-wave suggestive of myocardial ischemia were significantly higher (P=0.005) in diabetic cohort than the control. About 17% of diabetics and 5.5%.

  18. Improved patient selection for cardiac resynchronization therapy by normalization of QRS duration to left ventricular dimension

    NARCIS (Netherlands)

    Zweerink, A.; Wu, L.; Roest, G.J. de; Nijveldt, R.; Cock, C.C. de; Rossum, A.C. van; Allaart, C.P.

    2017-01-01

    Aims: This study evaluates the relative importance of two components of QRS prolongation, myocardial conduction velocity and travel distance of the electrical wave front (i.e. path length), for the prediction of acute response to cardiac resynchronization therapy (CRT) in left bundle branch block

  19. Electron beam computed tomography (EBCT) funding protocol

    African Journals Online (AJOL)

    patients wro: 4.1.1 have presented with a chest pain syndrome suggesting cardiac ischaemia. AND. 4.1.2.1 in whom alternative non-invasive testing has yielded ... bundle-branch block, Wolff-Parkinson-White syndrome, left ventricular hypertrophy or concomitant digitalis administration) or the interpretation of an alternative.

  20. Assessment of Tigecycline Prescription and Patients' Outcomes at ...

    African Journals Online (AJOL)

    mellitus; DMD, Duchenne muscular dystrophy; ESRD, end-stage renal disease; HTN, hypertension; HCV, hepatitis C virus; IHD, ischemic heart disease; IPF, interstitial pulmonary fibrosis; LBBB, left bundle branch block;. LVH, left ventricular hypertrophy; MR, mental retardation; MVR, mitral valve stenosis; MVS, mitral valve.

  1. Idiopathic Fascicular Left Ventricular Tachycardia.

    Science.gov (United States)

    Alahmad, Yaser; Asaad, Nidal Ahmad; Arafa, Salaheddin Omran; Ahmad Khan, Shahul Hameed; Mahmoud, Alsayed

    2017-01-01

    Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia.

  2. Sol Dal Blok Sol Aks Morfolojili Taşikardi Olgusu

    OpenAIRE

    AÇIKGÖZ, Nusret; KILIÇ, Ayhan; JATA, Bekim; BARÇIN, Cem; KÖSE, Sedat

    2014-01-01

    Accurate diagnosis of tachyarrhythmias is of vital importance for correct management. Diagnosis of wide QRS complex tachycardias sometimes pose serious difficulties. We aimed to present the differential diagnosis and ablative treatment of a young man with a wide QRS complex tachycardia with left bundle branch block pattern and left axis deviation, further complicated by the presence of a persistent vena cava superior.

  3. Idiopathic Fascicular Left Ventricular Tachycardia

    OpenAIRE

    Alahmad, Yaser; Asaad, Nidal Ahmad; Arafa, Salaheddin Omran; Ahmad Khan, Shahul Hameed; Mahmoud, Alsayed

    2017-01-01

    Idiopathic left fascicular ventricular tachycardia (ILFVT) is characterized by right bundle branch block morphology and left axis deviation. We report a case of idiopathic left ventricular fascicular tachycardia in a young 31-year-old male patient presenting with a narrow complex tachycardia.

  4. EAMJ Nov. HIV-.indd

    African Journals Online (AJOL)

    2008-11-11

    Nov 11, 2008 ... incomplete right bundle branch block and evidence of right atrial overload. ... any other cardiac shunts were found. Full blood count and ... In another smaller study, Petitpretz et al (6) also reported significant improvement in the haemodynamics in patients on epoprostenol. Epoprostenol has well described ...

  5. Multi-block and path modelling procedures

    DEFF Research Database (Denmark)

    Høskuldsson, Agnar

    2008-01-01

    The author has developed a unified theory of path and multi-block modelling of data. The data blocks are arranged in a directional path. Each data block can lead to one or more data blocks. It is assumed that there is given a collection of input data blocks. Each of them is supposed to describe one...... that lead to it. Methods of standard regression analysis are extended to this type of modelling. Three types of 'strengths' of relationship are computed for each set of two connected data blocks. First is the strength in the path, second the strength where only the data blocks leading to the last one...... are used and third if only the two are considered. Cross-validation and other standard methods of linear regression are carried out in a similar manner. In industry, processes are organised in different ways. It can be useful to model the processes in the way they are carried out. By proper alignment...

  6. A sharp recovery condition for block sparse signals by block orthogonal multi-matching pursuit

    OpenAIRE

    Chen, Wengu; Ge, Huanmin

    2016-01-01

    We consider the block orthogonal multi-matching pursuit (BOMMP) algorithm for the recovery of block sparse signals. A sharp bound is obtained for the exact reconstruction of block $K$-sparse signals via the BOMMP algorithm in the noiseless case, based on the block restricted isometry constant (block-RIC). Moreover, we show that the sharp bound combining with an extra condition on the minimum $\\ell_2$ norm of nonzero blocks of block $K-$sparse signals is sufficient to recover the true support ...

  7. Continuous-time block-monotone Markov chains and their block-augmented truncations

    OpenAIRE

    Masuyama, Hiroyuki

    2015-01-01

    This paper considers continuous-time block-monotone Markov chains (BMMCs) and their block-augmented truncations. We first introduce the block monotonicity and block-wise dominance relation for continuous-time Markov chains, and then provide some fundamental results on the two notions. Using these results, we show that the stationary distribution vectors obtained by the block-augmented truncation converge to the stationary distribution vector of the original BMMC. We also show that the last-co...

  8. Nonparametric weighted stochastic block models

    Science.gov (United States)

    Peixoto, Tiago P.

    2018-01-01

    We present a Bayesian formulation of weighted stochastic block models that can be used to infer the large-scale modular structure of weighted networks, including their hierarchical organization. Our method is nonparametric, and thus does not require the prior knowledge of the number of groups or other dimensions of the model, which are instead inferred from data. We give a comprehensive treatment of different kinds of edge weights (i.e., continuous or discrete, signed or unsigned, bounded or unbounded), as well as arbitrary weight transformations, and describe an unsupervised model selection approach to choose the best network description. We illustrate the application of our method to a variety of empirical weighted networks, such as global migrations, voting patterns in congress, and neural connections in the human brain.

  9. Cryptanalysis of Selected Block Ciphers

    DEFF Research Database (Denmark)

    Alkhzaimi, Hoda A.

    ciphers initiatives, and the Competition for Authenticated Encryption: Security, Applicability, and Robustness (CAESAR). In this thesis, we first present cryptanalytic results on different ciphers. We propose attack named the Invariant Subspace Attack. It is utilized to break the full block cipher...... PRINTcipher for a significant fraction of its keys. This new attack also gives us new insights into other, more well-established attacks. In addition, we also show that for weak keys, strongly biased linear approximations exists for any number of rounds. Furthermore, we provide variety of attacks...... thoroughly, no security assessment is given. We present a series of observations on the presented construction that, in some cases, yield attacks, while in other cases may provide basis of further analysis by the cryptographic community. Specifically, The attacks obtained are using classical- as well...

  10. A MAC Mode for Lightweight Block Ciphers

    DEFF Research Database (Denmark)

    Luykx, Atul; Preneel, Bart; Tischhauser, Elmar Wolfgang

    2016-01-01

    Lightweight cryptography strives to protect communication in constrained environments without sacrificing security. However, security often conflicts with efficiency, shown by the fact that many new lightweight block cipher designs have block sizes as low as 64 or 32 bits. Such low block sizes le......MAC is not covered by patents. Altogether, this makes it a promising authentication primitive for a wide range of platforms and use cases....

  11. Multiple-Block Ahead Branch Predictors

    OpenAIRE

    Seznec, André; Jourdan, Stéphan; Sainrat, Pascal; Michaud, Pierre

    1996-01-01

    A basic rule in computer architecture is that a processor cannot execute an application faster than it fetches its instructions. To overcome the instruction fetch bottleneck shown in wide-dispatch «brainiac» processors, this paper presents a novel cost-effective mechanism called the multiple-block ahead branch predictor that predicts in an efficient way addresses of multiple basic blocks in a single cycle. Moreover and unlike the previous multiple predictor schemes, the multiple-block ahead b...

  12. Modeling Haplotype Block Variation Using Markov Chains

    OpenAIRE

    Greenspan, G.; Geiger, D.

    2006-01-01

    Models of background variation in genomic regions form the basis of linkage disequilibrium mapping methods. In this work we analyze a background model that groups SNPs into haplotype blocks and represents the dependencies between blocks by a Markov chain. We develop an error measure to compare the performance of this model against the common model that assumes that blocks are independent. By examining data from the International Haplotype Mapping project, we show how the Markov model over hap...

  13. Modelling of multi-block data

    DEFF Research Database (Denmark)

    Høskuldsson, Agnar; Svinning, K.

    2006-01-01

    Here is presented a unified approach to modelling multi-block regression data. The starting point is a partition of the data X into L data blocks, X = (X-1, X-2,...X-L), and the data Y into M data-blocks, Y = (Y-1, Y-2,...,Y-M). The methods of linear regression, X -> Y, are extended to the case...... these methods can be extended to a network of data blocks. Examples of the optimisation procedures in a network are shown. The examples chosen are the ones that are useful to work within industrial production environments. The methods are illustrated by simulated data and data from cement production....

  14. Using Interference to Block RFID Tags

    DEFF Research Database (Denmark)

    Krigslund, Rasmus; Popovski, Petar; Pedersen, Gert Frølund

    We propose a novel method to block RFID tags from responding, using intentional interference. We focus on the experimental evaluation, where we impose interference on the download and uplink, respectively. The results are positive, where modulated CCI shows most effective to block a tag.......We propose a novel method to block RFID tags from responding, using intentional interference. We focus on the experimental evaluation, where we impose interference on the download and uplink, respectively. The results are positive, where modulated CCI shows most effective to block a tag....

  15. A MAC Mode for Lightweight Block Ciphers

    DEFF Research Database (Denmark)

    Luykx, Atul; Preneel, Bart; Tischhauser, Elmar Wolfgang

    2016-01-01

    Lightweight cryptography strives to protect communication in constrained environments without sacrificing security. However, security often conflicts with efficiency, shown by the fact that many new lightweight block cipher designs have block sizes as low as 64 or 32 bits. Such low block sizes lead...... no effect on the security bound, allowing an order of magnitude more data to be processed per key. Furthermore, LightMAC is incredibly simple, has almost no overhead over the block cipher, and is parallelizable. As a result, LightMAC not only offers compact authentication for resource-constrained platforms...

  16. Capturing Reality at Centre Block

    Science.gov (United States)

    Boulanger, C.; Ouimet, C.; Yeomans, N.

    2017-08-01

    The Centre Block of Canada's Parliament buildings, National Historic Site of Canada is set to undergo a major rehabilitation project that will take approximately 10 years to complete. In preparation for this work, Heritage Conservation Services (HCS) of Public Services and Procurement Canada has been completing heritage documentation of the entire site which includes laser scanning of all interior rooms and accessible confined spaces such as attics and other similar areas. Other documentation completed includes detailed photogrammetric documentation of rooms and areas of high heritage value. Some of these high heritage value spaces present certain challenges such as accessibility due to the height and the size of the spaces. Another challenge is the poor lighting conditions, requiring the use of flash or strobe lighting to either compliment or completely eliminate the available ambient lighting. All the spaces captured at this higher level of detail were also captured with laser scanning. This allowed the team to validate the information and conduct a quality review of the photogrammetric data. As a result of this exercise, the team realized that in most, if not all cases, the photogrammetric data was more detailed and at a higher quality then the terrestrial laser scanning data. The purpose and motivation of this paper is to present these findings, as well provide the advantages and disadvantages of the two methods and data sets.

  17. Block co-polypeptide and hydrogels made thereof

    NARCIS (Netherlands)

    Wolf, de F.A.; Werten, M.W.T.; Moers, A.P.H.A.; Wolbert, E.J.H.; Eggink, G.

    2009-01-01

    Disclosed is a block co-polypeptide comprising at least two blocks T and at least one block S, with blocks T and S alternating, wherein each T independently denotes a Trimerizing Block being a polypeptide block capable of forming a thermoreversible collagen-like triple helix structure, and

  18. Optimization of Blocked Designs in fMRI Studies

    Science.gov (United States)

    Maus, Barbel; van Breukelen, Gerard J. P.; Goebel, Rainer; Berger, Martijn P. F.

    2010-01-01

    Blocked designs in functional magnetic resonance imaging (fMRI) are useful to localize functional brain areas. A blocked design consists of different blocks of trials of the same stimulus type and is characterized by three factors: the length of blocks, i.e., number of trials per blocks, the ordering of task and rest blocks, and the time between…

  19. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block

    DEFF Research Database (Denmark)

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V

    2015-01-01

    healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated...... into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block...... and the abdominal muscle-relaxing effect. RESULTS: The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6...

  20. Adhesive arachnoiditis in patients with spinal block

    Energy Technology Data Exchange (ETDEWEB)

    Skalpe, I.O.; Sortland, O.

    1982-01-01

    Adhesive arachnoiditis was found in eight patients and spinal block was found in 7 of these in a series of 330 patients refered for thoracic myelography. This variety of adhesive arachnoiditis seems to be caused by spinal block/high CSF protein concentration.

  1. Block Gas Sol Unit in Haderslev

    DEFF Research Database (Denmark)

    Vejen, Niels Kristian

    2000-01-01

    Investigation of a SDHW system based on a Block Gas Sol Unit from Baxi A/S installed by a consumer i Haderslev, Denmark.......Investigation of a SDHW system based on a Block Gas Sol Unit from Baxi A/S installed by a consumer i Haderslev, Denmark....

  2. Combinatorics of block designs and finite geometries

    Indian Academy of Sciences (India)

    2013-11-10

    Nov 10, 2013 ... many points and blocks), quasi-symmetric designs (which have two block intersection .... We have already seen the special example of Fano plane. In general, we .... actually construct a symmetric design from a group. This is ...

  3. Second derivative parallel block backward differentiation type ...

    African Journals Online (AJOL)

    A class of second derivative parallel block Backward differentiation type formulas is developed and the methods are inherently parallel and can be distributed over parallel processors. They are L–stable for block size k 6 with small error constants when compared to the conventional sequential Linear multi –step methods of ...

  4. CONJUGATED BLOCK-COPOLYMERS FOR ELECTROLUMINESCENT DIODES

    NARCIS (Netherlands)

    Hilberer, A; Gill, R.E; Herrema, J.K; Malliaras, G.G; Wildeman, J.; Hadziioannou, G

    In this article we review results obtained in our laboratory on the design and study of new light-emitting polymers. We are interested in the synthesis and characterisation of block copolymers with regularly alternating conjugated and non conjugated sequences. The blocks giving rise to luminescence

  5. Structure of building blocks in amylopectins.

    Science.gov (United States)

    Bertoft, Eric; Koch, Kristine; Man, Per

    2012-11-01

    Building blocks represent the smallest, branched units found inside clusters of amylopectins. The building blocks from clusters of 10 different amylopectins, representing a wide variety of plants, were isolated and size-fractionated. The unit chain compositions were then analysed. It was found that the number of chains in building blocks increased in proportion to their size similarly in all samples regardless plant source. The smallest blocks (DP 5-9) consisted of 2 chains and the largest blocks (DP ≥45), of which generally only little existed, possessed ≥10 chains. Generally, the degree of branching increased with building block size, but the organisation of chains inside the blocks was unique for each sample. Nevertheless, compared to other plants, amylopectins from cereals (represented by rye, oats, rice and waxy maize) possessing elevated number of the shortest internal B-chains (DP 3-7), tended to have blocks with a lower ratio of A:B-chains, indicative of a preferred Haworth type of structure as opposed to the Staudinger configuration. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Blocks of monodromy groups in complex dynamics

    NARCIS (Netherlands)

    Jones, R.; Peters, H.

    2011-01-01

    Motivated by a problem in complex dynamics, we examine the block structure of the natural action of iterated monodromy groups on the tree of preimages of a generic point. We show that in many cases, including when the polynomial has prime power degree, there are no large blocks other than those

  7. The undesirable effects of neuromuscular blocking drugs

    DEFF Research Database (Denmark)

    Claudius, C; Garvey, L H; Viby-Mogensen, J

    2009-01-01

    Neuromuscular blocking drugs are designed to bind to the nicotinic receptor at the neuromuscular junction. However, they also interact with other acetylcholine receptors in the body. Binding to these receptors causes adverse effects that vary with the specificity for the cholinergic receptor...... in question. Moreover, all neuromuscular blocking drugs may cause hypersensitivity reactions. Often the symptoms are mild and self-limiting but massive histamine release can cause systematic reactions with circulatory and respiratory symptoms and signs. At the end of anaesthesia, no residual effect...... of a neuromuscular blocking drug should be present. However, the huge variability in response to neuromuscular blocking drugs makes it impossible to predict which patient will suffer postoperative residual curarization. This article discusses the undesirable effects of the currently available neuromuscular blocking...

  8. Block copolymer structures in nano-pores

    Science.gov (United States)

    Pinna, Marco; Guo, Xiaohu; Zvelindovsky, Andrei

    2010-03-01

    We present results of coarse-grained computer modelling of block copolymer systems in cylindrical and spherical nanopores on Cell Dynamics Simulation. We study both cylindrical and spherical pores and systematically investigate structures formed by lamellar, cylinders and spherical block copolymer systems for various pore radii and affinity of block copolymer blocks to the pore walls. The obtained structures include: standing lamellae and cylinders, ``onions,'' cylinder ``knitting balls,'' ``golf-ball,'' layered spherical, ``virus''-like and mixed morphologies with T-junctions and U-type defects [1]. Kinetics of the structure formation and the differences with planar films are discussed. Our simulations suggest that novel porous nano-containers can be formed by confining block copolymers in pores of different geometries [1,2]. [4pt] [1] M. Pinna, X. Guo, A.V. Zvelindovsky, Polymer 49, 2797 (2008).[0pt] [2] M. Pinna, X. Guo, A.V. Zvelindovsky, J. Chem. Phys. 131, 214902 (2009).

  9. Paravertebral Block Plus Thoracic Wall Block versus Paravertebral Block Alone for Analgesia of Modified Radical Mastectomy: A Retrospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Nai-Liang Li

    Full Text Available Paravertebral block placement was the main anesthetic technique for modified radical mastectomy in our hospital until February 2014, when its combination with blocks targeting the pectoral musculature was initiated. We compared the analgesic effects of paravertebral blocks with or without blocks targeting the pectoral musculature for modified radical mastectomy.We retrospectively collected data from a single surgeon and anesthesiologist from June 1, 2012, to May 31, 2015. Intraoperative sedatives and analgesic requirements, time to the first analgesic request, postoperative analgesic doses, patient satisfaction, and complications were compared.Fifty-four patients received a paravertebral block alone (PECS 0, and 46 received a paravertebral block combined with blocks targeting the pectoral musculature (PECS 1. The highest intraoperative effect-site concentration of propofol was significantly lower in the PECS 1 group than in the PECS 0 group [2.3 (1.5, 2.8 vs 2.5 (1.5, 4 μg/mL, p = 0.0014]. The intraoperative rescue analgesic dose was significantly lower in the PECS 1 group [0 (0, 25 vs 0 (0, 75 mg of ketamine, p = 0.0384]. Furthermore, the PECS 1 group had a significantly longer time to the first analgesic request [636.5 (15, 720 vs 182.5 (14, 720 min, p = 0.0001]. After further adjustment for age, body mass index, American Society of Anesthesiologists Physical Status classification, chronic pain history, incidence of a superficial cervical plexus block placement, and operation duration, blocks targeting the pectoral musculature were determined to be the only significant factor (hazard ratio, 0.36; 95% confidence interval, 0.23-0.58; p < 0.0001. Very few patients used potent analgesics including morphine and ketorolac; the cumulative use of morphine or ketorolac was similar in the study groups. However, the incidence of all analgesic use, namely morphine, ketorolac, acetaminophen, and celecoxib, was significantly lower in the PECS 1 group [3

  10. Atmospheric Blocking in the Northern Hemisphere.

    Science.gov (United States)

    Knox, John Lewis

    Blocking is generally understood as the obstruction on a large scale of the normal west - to - east motion of mid-latitude pressure systems. It is a persistent phenomenon lasting from one to several weeks and the resulting prolonged weather regimes may have serious economic and social consequences. The recent Northern Hemisphere winters, starting with 1976 -77, featured unusually large circulation anomalies, many of which can be directly related to prolonged episodes of large scale blocking. The intent of this study is to investigate the statistics and certain diagnostics of blocking in the Northern Hemisphere. The first of the three primary objectives is to present and interpret the spatial and temporal distribution of blocking during the past 33 years. We develop objective identification criteria, adaptable to machine processing methods, by relating the blocking anticyclone to its associated positive anomaly of 5-day mean 500MB height. Anomalies meeting the criteria are called 'blocking signatures.' We present the seasonal frequency of occurrence of these signatures by longitude and by area. The results are in good agreement with published studies for the oceans, but they also reveal a high frequency of blocking signatures over the Northeastern Canadian Archipelago. This result, dubbed the 'Baffin Island Paradox' is further investigated and rationalized. A catalogue has been prepared which identifies the date, centre location and magnitude of every blocking signature which occurred from January 1, 1946 to December 31, 1978. A supplementary Catalogue identifies sequences of these signatures corresponding to actual blocking episodes. The second objective is to investigate whether regions with high incidence of blocking, in either the developing or the mature stage, features non-Gaussian distributions of 5-day mean geopotential. During winter, fields of significantly low kurtosis are found in certain mid-latitude regions where the genesis and amplification of

  11. Therapeutic efficacy of facet joint blocks.

    Science.gov (United States)

    Gorbach, Christoph; Schmid, Marius R; Elfering, Achim; Hodler, Juerg; Boos, Norbert

    2006-05-01

    The objective of our study was to investigate outcome predictors of short- and medium-term therapeutic efficacy of facet joint blocks. Forty-two patients with chronic lower back pain who were undergoing facet joint blocks at one (n = 29) or two (n = 13) levels were analyzed. All patients underwent MRI or CT of the lumbar spine within 5 months before the facet joint blocks. The facet joint blocks were performed under fluoroscopic guidance. A small amount ( 1 week) and medium-term effect (> 3 months), were collected by a structured telephone interview. CT and MRI were reviewed with regard to the extent of facet joint abnormalities. Multiple logistic regression analyses were conducted to identify outcome predictor for efficacy of facet joint blocks. A positive immediate effect was seen in 31 patients (74%). A positive medium-term effect was found in 14 patients (33%). Pain alleviated by motion (p = 0.035) and the absence of joint-blocking sensation (p = 0.042) predicted pain relief. However, the extent of facet joint osteoarthritis on MRI and CT was not a significant predictor for outcome (p = 0.57-0.95). Facet joint blocks appear to have a beneficial medium-term effect in one third of patients with chronic lower back pain and may therefore be a reasonable adjunct to nonoperative treatment. However, outcome appears to depend on clinical, not on morphologic, imaging findings.

  12. Development of Alkali Activated Geopolymer Masonry Blocks

    Science.gov (United States)

    Venugopal, K.; Radhakrishna; Sasalatti, Vinod

    2016-09-01

    Cement masonry units are not considered as sustainable since their production involves consumption of fuel, cement and natural resources and therefore it is essential to find alternatives. This paper reports on making of geopolymer solid & hollow blocks and masonry prisms using non conventional materials like fly ash, ground granulated blast furnace slag (GGBFS) and manufactured sand and curing at ambient temperature. They were tested for water absorption, initial rate of water absorption, dry density, dimensionality, compressive, flexural and bond-strength which were tested for bond strength with and without lateral confinement, modulus of elasticity, alternative drying & wetting and masonry efficiency. The properties of geopolymer blocks were found superior to traditional masonry blocks and the masonry efficiency was found to increase with decrease in thickness of cement mortar joints. There was marginal difference in strength between rendered and unrendered geopolymer masonry blocks. The percentage weight gain after 7 cycles was less than 6% and the percentage reduction in strength of geopolymer solid blocks and hollow blocks were 26% and 28% respectively. Since the properties of geopolymer blocks are comparatively better than the traditional masonry they can be strongly recommended for structural masonry.

  13. Gaussian curvature analysis allows for automatic block placement in multi-block hexahedral meshing.

    Science.gov (United States)

    Ramme, Austin J; Shivanna, Kiran H; Magnotta, Vincent A; Grosland, Nicole M

    2011-10-01

    Musculoskeletal finite element analysis (FEA) has been essential to research in orthopaedic biomechanics. The generation of a volumetric mesh is often the most challenging step in a FEA. Hexahedral meshing tools that are based on a multi-block approach rely on the manual placement of building blocks for their mesh generation scheme. We hypothesise that Gaussian curvature analysis could be used to automatically develop a building block structure for multi-block hexahedral mesh generation. The Automated Building Block Algorithm incorporates principles from differential geometry, combinatorics, statistical analysis and computer science to automatically generate a building block structure to represent a given surface without prior information. We have applied this algorithm to 29 bones of varying geometries and successfully generated a usable mesh in all cases. This work represents a significant advancement in automating the definition of building blocks.

  14. Measurement of soil moisture using gypsum blocks

    DEFF Research Database (Denmark)

    Friis Dela, B.

    For the past 50 years, gypsum blocks have been used to determine soil moisture content. This report describes a method for calibrating gypsum blocks for soil moisture measurements. Moisture conditions inside a building are strongly influenced by the moisture conditions in the soil surrounding...... the building. Consequently, measuring the moisture of the surrounding soil is of great importance for detecting the source of moisture in a building. Up till now, information has been needed to carry out individual calibrations for the different types of gypsum blocks available on the market and to account...

  15. Lidocaine block of cardiac sodium channels

    OpenAIRE

    Bean, BP; Cohen, CJ; Tsien, RW

    1983-01-01

    Lidocaine block of cardiac sodium channels was studied in voltage-clamped rabbit purkinje fibers at drug concentrations ranging from 1 mM down to effective antiarrhythmic doses (5-20 ?M). Dose-response curves indicated that lidocaine blocks the channel by binding one-to-one, with a voltage-dependent K(d). The half-blocking concentration varied from more than 300 ?M, at a negative holding potential where inactivation was completely removed, to approximately 10 ?M, at a depolarized holding pote...

  16. Comparison of Two Techniques of Brachial Plexus Block for Upper ...

    African Journals Online (AJOL)

    The study compared trans-arterial approach and mid-humeral technique of axillary brachial plexus block in terms of the clinical benefit of each method; adequacy of block, onset of sensory and motor block, duration of block and complications. .In a prospective randomized study, axillary plexus block was carried out in 50 ...

  17. Evidence of peripheral nerve blocks for cancer-related pain

    DEFF Research Database (Denmark)

    Klepstad, P; Kurita, G P; Mercadante, S

    2015-01-01

    retrieved was 155. No controlled studies were identified. Sixteen papers presented a total of 79 cases. The blocks applied were paravertebral blocks (10 cases), blocks in the head region (2 cases), plexus blocks (13 cases), intercostal blocks (43 cases) and others (11 cases). In general, most cases reported...

  18. Exploring Energy Efficiency of Lightweight Block Ciphers

    DEFF Research Database (Denmark)

    Banik, Subhadeep; Bogdanov, Andrey; Regazzoni, Francesco

    2016-01-01

    lightweight block ciphers, and thereby try to predict the optimal value of r at which an r-round unrolled architecture for a cipher is likely to be most energy efficient. We also try to relate our results to some physical design parameters like the signal delay across a round and algorithmic parameters like......In the last few years, the field of lightweight cryptography has seen an influx in the number of block ciphers and hash functions being proposed. One of the metrics that define a good lightweight design is the energy consumed per unit operation of the algorithm. For block ciphers, this operation...... is the encryption of one plaintext. By studying the energy consumption model of a CMOS gate, we arrive at the conclusion that the energy consumed per cycle during the encryption operation of an r-round unrolled architecture of any block cipher is a quadratic function in r. We then apply our model to 9 well known...

  19. EnviroAtlas - Cleveland, OH - Block Groups

    Data.gov (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas dataset is the base layer for the Cleveland, OH EnviroAtlas community. The block groups are from the US Census Bureau and are included/excluded...

  20. Ultrasound guided nerve block for breast surgery.

    Science.gov (United States)

    Diéguez, P; Casas, P; López, S; Fajardo, M

    2016-03-01

    The breast surgery has undergone changes in recent years, encouraging new initiatives for the anaesthetic management of these patients in order to achieve maximum quality and rapid recovery. The fundamental tool that has allowed a significant improvement in the progress of regional anaesthesia for breast disease has been ultrasound, boosting the description and introduction into clinical practice of interfascial chest wall blocks, although the reference standard is still the paravertebral block. It is very likely that these blocks will change the protocols in the coming years. A review is presented of the anatomy of the breast region, description of nerve blocks and techniques, as well as their indications, all according to published articles and the opinion of the authors based on their experience. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Functional Nanoporous Polymers from Block Copolymer Precursors

    DEFF Research Database (Denmark)

    Guo, Fengxiao

    applications as, e.g., membranes for separation and purification, templates for nanostructured materials, sensors, substrates for catalysis, low dielectric constant materials, photonic materials, and depots for controlled drug delivery. The development of nanoporous polymers with well controlled pore wall......Abstract Self-assembly of block copolymers provides well-defined morphologies with characteristic length scales in the nanometer range. Nanoporous polymers prepared by selective removal of one block from self-assembled block copolymers offer great technological promise due to their many potential...... functionalities remains a great challenge due to the limitation of available polymer synthesis and the nanoscale confinement of the porous cavities. The main topic of this thesis is to develop methods for fabrication of functional nanoporous polymers from block copolymer precursors. A method has been developed...

  2. Micellization and Characterization of Block Copolymer Detergents

    DEFF Research Database (Denmark)

    Hvidt, Søren

    depending on block length ratios and temperature. The micellization process with increasing temperature or concentration has been followed by a number of techniques including differential scanning calorimetry and surface tension measurements. The detailed micellar mechanism is not well understood...

  3. EnviroAtlas - Woodbine, IA - Block Groups

    Data.gov (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas dataset is the base layer for the Woodbine, IA EnviroAtlas area. The block groups are from the US Census Bureau and are included/excluded based on...

  4. EnviroAtlas - Durham, NC - Block Groups

    Data.gov (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas dataset is the base layer for the Durham, NC EnviroAtlas Area. The block groups are from the US Census Bureau and are included/excluded based on...

  5. Blocking Detection Based on Synoptic Filters

    Directory of Open Access Journals (Sweden)

    Bernd Schalge

    2011-01-01

    minimum zonal width, and (iii a persistence filter to extract events with a minimum duration. Practical filter application is analysed in two case studies and the blocking climatologies for the Northern and the Southern Hemisphere.

  6. EnviroAtlas - Austin, TX - Block Groups

    Data.gov (United States)

    U.S. Environmental Protection Agency — This EnviroAtlas dataset is the base layer for the Austin, TX EnviroAtlas area. The block groups are from the US Census Bureau and are included/excluded based on...

  7. Electrostatic control of block copolymer morphology

    Science.gov (United States)

    Sing, Charles E.; Zwanikken, Jos W.; Olvera de La Cruz, Monica

    2014-07-01

    Energy storage is at present one of the foremost issues society faces. However, material challenges now serve as bottlenecks in technological progress. Lithium-ion batteries are the current gold standard to meet energy storage needs; however, they are limited owing to the inherent instability of liquid electrolytes. Block copolymers can self-assemble into nanostructures that simultaneously facilitate ion transport and provide mechanical stability. The ions themselves have a profound, yet previously unpredictable, effect on how these nanostructures assemble and thus the efficiency of ion transport. Here we demonstrate that varying the charge of a block copolymer is a powerful mechanism to predictably tune nanostructures. In particular, we demonstrate that highly asymmetric charge cohesion effects can induce the formation of nanostructures that are inaccessible to conventional uncharged block copolymers, including percolated phases desired for ion transport. This vastly expands the design space for block copolymer materials and is informative for the versatile design of battery electrolyte materials.

  8. Functionalization of Block Copolymer Vesicle Surfaces

    Directory of Open Access Journals (Sweden)

    Wolfgang Meier

    2011-01-01

    Full Text Available In dilute aqueous solutions certain amphiphilic block copolymers self-assemble into vesicles that enclose a small pool of water with a membrane. Such polymersomes have promising applications ranging from targeted drug-delivery devices, to biosensors, and nanoreactors. Interactions between block copolymer membranes and their surroundings are important factors that determine their potential biomedical applications. Such interactions are influenced predominantly by the membrane surface. We review methods to functionalize block copolymer vesicle surfaces by chemical means with ligands such as antibodies, adhesion moieties, enzymes, carbohydrates and fluorophores. Furthermore, surface-functionalization can be achieved by self-assembly of polymers that carry ligands at their chain ends or in their hydrophilic blocks. While this review focuses on the strategies to functionalize vesicle surfaces, the applications realized by, and envisioned for, such functional polymersomes are also highlighted.

  9. Isolated dextrocardia and congenital heart blocking

    OpenAIRE

    Khoury, Maurice; Harbieh, Bernard; Heriopian, Aline

    2015-01-01

    To our knowledge, isolated dextrocardia in association with congenital complete atrioventricular heart block has not been previously reported. We report such a case, elaborate on the possible pathogenesis, and present our experience with management.

  10. Block copolymer membranes for aqueous solution applications

    KAUST Repository

    Nunes, Suzana Pereira

    2016-03-22

    Block copolymers are known for their intricate morphology. We review the state of the art of block copolymer membranes and discuss perspectives in this field. The main focus is on pore morphology tuning with a short introduction on non-porous membranes. The two main strategies for pore formation in block copolymer membranes are (i) film casting and selective block sacrifice and (ii) self-assembly and non-solvent induced phase separation (SNIPS). Different fundamental aspects involved in the manufacture of block copolymer membranes are considered, including factors affecting the equilibrium morphology in solid films, self-assembly of copolymer in solutions and macrophase separation by solvent-non-solvent exchange. Different mechanisms are proposed for different depths of the SNIPS membrane. Block copolymer membranes can be prepared with much narrower pore size distribution than homopolymer membranes. Open questions and indications of what we consider the next development steps are finally discussed. They include the synthesis and application of new copolymers and specific functionalization, adding characteristics to respond to stimuli and chemical environment, polymerization-induced phase separation, and the manufacture of organic-inorganic hybrids.

  11. Dietary cholesterol modulates pathogen blocking by Wolbachia.

    Directory of Open Access Journals (Sweden)

    Eric P Caragata

    Full Text Available The bacterial endosymbiont Wolbachia pipientis protects its hosts from a range of pathogens by limiting their ability to form infections inside the insect. This "pathogen blocking" could be explained by innate immune priming by the symbiont, competition for host-derived resources between pathogens and Wolbachia, or the direct modification of the cell or cellular environment by Wolbachia. Recent comparative work in Drosophila and the mosquito Aedes aegypti has shown that an immune response is not required for pathogen blocking, implying that there must be an additional component to the mechanism. Here we have examined the involvement of cholesterol in pathogen blocking using a system of dietary manipulation in Drosophila melanogaster in combination with challenge by Drosophila C virus (DCV, a common fly pathogen. We observed that flies reared on cholesterol-enriched diets infected with the Wolbachia strains wMelPop and wMelCS exhibited reduced pathogen blocking, with viral-induced mortality occurring 2-5 days earlier than flies reared on Standard diet. This shift toward greater virulence in the presence of cholesterol also corresponded to higher viral copy numbers in the host. Interestingly, an increase in dietary cholesterol did not have an effect on Wolbachia density except in one case, but this did not directly affect the strength of pathogen blocking. Our results indicate that host cholesterol levels are involved with the ability of Wolbachia-infected flies to resist DCV infections, suggesting that cholesterol contributes to the underlying mechanism of pathogen blocking.

  12. Capacitor blocks for linear transformer driver stages.

    Science.gov (United States)

    Kovalchuk, B M; Kharlov, A V; Kumpyak, E V; Smorudov, G V; Zherlitsyn, A A

    2014-01-01

    In the Linear Transformer Driver (LTD) technology, the low inductance energy storage components and switches are directly incorporated into the individual cavities (named stages) to generate a fast output voltage pulse, which is added along a vacuum coaxial line like in an inductive voltage adder. LTD stages with air insulation were recently developed, where air is used both as insulation in a primary side of the stages and as working gas in the LTD spark gap switches. A custom designed unit, referred to as a capacitor block, was developed for use as a main structural element of the transformer stages. The capacitor block incorporates two capacitors GA 35426 (40 nF, 100 kV) and multichannel multigap gas switch. Several modifications of the capacitor blocks were developed and tested on the life time and self breakdown probability. Blocks were tested both as separate units and in an assembly of capacitive module, consisting of five capacitor blocks. This paper presents detailed design of capacitor blocks, description of operation regimes, numerical simulation of electric field in the switches, and test results.

  13. Synthesis of segmented (pb(ps-block-pb)(n)) and (pb(san-block- pb)(n)) block-copolymers via polymeric thermal iniferters

    NARCIS (Netherlands)

    Kroeze, E; ten Brinke, G.; Hadziioannou, G

    1995-01-01

    A technique is described for the synthesis of segmented poly(butadiene-block-styrene) block copolymers and segmented poly(butadiene-block-(styrene-co-acrylonitrile)) block copolymers through polybutadiene-based thermal iniferters. Dihydroxy- and dicarboxy-terminated polybutadienes were transformed

  14. Implicit Block Diagonal Low-Rank Representation.

    Science.gov (United States)

    Xie, Xingyu; Guo, Xianglin; Liu, Guangcan; Wang, Jun

    2017-10-17

    While current block diagonal constrained subspace clustering methods are performed explicitly on the original data space, in practice it is often more desirable to embed the block diagonal prior into the reproducing kernel Hilbert feature space by kernelization techniques, as the underlying data structure in reality is usually nonlinear. However, it is still unknown how to carry out the embedding and kernelization in the models with block diagonal constraints. In this work, we shall take a step in this direction. First, we establish a novel model termed Implicit Block Diagonal Low-Rank Representation (IBDLR), by incorporating the implicit feature representation and block diagonal prior into the prevalent Low-Rank Representation (LRR) method. Second, mostly important, we show that the model in IBDLR could be kernelized by making use of a smoothed dual representation and the specifics of a proximal gradient based optimization algorithm. Finally, we provide some theoretical analyses for the convergence of our optimization algorithm. Comprehensive experiments on synthetic and realworld datasets demonstrate the superiorities of our IBDLR over state-of-the-art methods.While current block diagonal constrained subspace clustering methods are performed explicitly on the original data space, in practice it is often more desirable to embed the block diagonal prior into the reproducing kernel Hilbert feature space by kernelization techniques, as the underlying data structure in reality is usually nonlinear. However, it is still unknown how to carry out the embedding and kernelization in the models with block diagonal constraints. In this work, we shall take a step in this direction. First, we establish a novel model termed Implicit Block Diagonal Low-Rank Representation (IBDLR), by incorporating the implicit feature representation and block diagonal prior into the prevalent Low-Rank Representation (LRR) method. Second, mostly important, we show that the model in IBDLR could be

  15. Turbulence Interface Simulation by Lagrangian Blocks

    Science.gov (United States)

    Chu, V. H.

    2015-12-01

    Most computational fluid-dynamics codes are developed using the Eulerian description. To find the numerical solution, fluxes are estimated on the surface of the finite volume using a truncation series. Spurious numerical oscillations and artificial numerical diffusion are consequences, particularly in regions across flow discontinuities. Diffusion often is introduced synthetically in many schemes to gain computational stability. Occasional switching to a diffusive upwind scheme, for example, is one classic strategy to manage the numerical oscillations [see e.g., Ghannadi & Chu 2015]. Lagrangian-block simulation offers an alternative that could minimize the spurious oscillations and false diffusive error. The blocks move in the direction of the flow. The squares of the block widths expand in proportion to the diffusivities. The block simulation procedure consists of (i) Lagrangian advection and diffusion, (ii) division into portions, and (iii) reassembly of the portions into new blocks. The blocks are renewed in each time increment to prevent excessive distortion. Details of the Lagrangian-block simulations method have been given in a series of papers by Tan & Chu (2012), Chu & Altai (2012, 2015}. In this paper, the exchanges across turbulence interfaces are considered for two problems. The first series of the simulations are conducted to find the mass and momentum exchanges across a shallow flow of two different depth. In the simulations, the advection and diffusion of three separated systems of blocks that contain the mass, momentum and potential vorticity are carried out using the Lagrangian-block simulation method. The simulation results are compared with data obtained from a previous laboratory investigation and related to the shear instability problem in rotating shear flow previously considered by Chu (2014). The second problem involves the turbulence generation across the interface of an internal waves. The simulation shows the development of gravitational

  16. Combined KHFAC + DC nerve block without onset or reduced nerve conductivity after block

    Science.gov (United States)

    Franke, Manfred; Vrabec, Tina; Wainright, Jesse; Bhadra, Niloy; Bhadra, Narendra; Kilgore, Kevin

    2014-10-01

    Objective. Kilohertz frequency alternating current (KHFAC) waveforms have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Approach. A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC + CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC + CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 s (range: 318-1563 s) of cumulative dc to investigate the impact of combined KHFAC + CBDC on nerve viability. Main results. The peak onset force was reduced significantly from 20.73 N (range: 18.6-26.5 N) with KHFAC alone to 0.45 N (range: 0.2-0.7 N) with the combined CBDC and KHFAC block waveform (p block relative to KHFAC waveforms. Significance. The distal application of CBDC can significantly reduce or even completely prevent the KHFAC onset response without a change in nerve conductivity.

  17. Fields of definition of building blocks

    Science.gov (United States)

    Quer, Jordi

    2009-03-01

    We investigate the fields of definition up to isogeny of the abelian varieties known as building blocks. These varieties are defined as the mathbb{Q} -varieties admitting real or quaternionic multiplications of the maximal possible degree allowed by their dimensions (cf. Pyle (2004)). The Shimura-Taniyama conjecture predicts that every such variety is isogenous to a non-CM simple factor of a modular Jacobian J_1(N) . The obstruction to descend the field of definition of a building block up to isogeny is given by Ribet in 1994 as an element in a Galois cohomology group. In this paper we begin by studying these elements from an abstract Galois-cohomological point of view, and obtain results and formulas for the computation of invariants related to them. When considered for the element attached to a building block, these invariants give the structure of its endomorphism algebra, and also complete information on the possible fields of definition up to isogeny of this building block. We implemented these computations in Magma for building blocks given as overline{mathbb{Q}} -simple factors up to isogeny of the Jacobian of the modular curve X_1(N) . Using this implementation we computed a table for conductors Nleq500 , which is described in the last section. This table is a source of examples of building blocks with different behaviors and of statistical information; in particular, it contains many examples that answer a question posed by Ribet in 1994 on the existence of a smallest field of definition up to isogeny for RM-building blocks of even dimension.

  18. Photo-Induced Micellization of Block Copolymers

    Directory of Open Access Journals (Sweden)

    Satoshi Kuwayama

    2010-11-01

    Full Text Available We found novel photo-induced micellizations through photolysis, photoelectron transfer, and photo-Claisen rearrangement. The photolysis-induced micellization was attained using poly(4-tert-butoxystyrene-block-polystyrene diblock copolymer (PBSt-b-PSt. BSt-b-PSt showed no self-assembly in dichloromethane and existed as isolated copolymers. Dynamic light scattering demonstrated that the copolymer produced spherical micelles in this solvent due to irradiation with a high-pressure mercury lamp in the presence of photo-acid generators, such as bis(alkylphenyliodonium hexafluorophosphate, diphenyliodonium hexafluorophosphate, and triphenylsulfonium triflate. The 1H NMR analysis confirmed that PBSt-b-PSt was converted into poly(4-vinylphenol-block-PSt by the irradiation, resulting in self-assembly into micelles. The irradiation in the presence of the photo-acid generator also induced the micellization of poly(4-pyridinemethoxymethylstyrene-block-polystyrene diblock copolymer (PPySt-b-PSt. Micellization occurred by electron transfer from the pyridine to the photo-acid generator in their excited states and provided monodispersed spherical micelles with cores of PPySt blocks. Further, the photo-Claisen rearrangement caused the micellization of poly(4-allyloxystyrene-block-polystyrene diblock copolymer (PASt-b-PSt. Micellization was promoted in cyclohexane at room temperature without a catalyst. During micellization, the elimination of the allyl groups competitively occurred along with the photorearrangement of the 4-allyloxystyrene units into the 3-allyl-4-hydroxystyrene units.

  19. PEO-related block copolymer surfactants

    DEFF Research Database (Denmark)

    Mortensen, K.

    2001-01-01

    Non-ionic block copolymer systems based on hydrophilic poly(ethylene oxide) and more hydrophobic co-polymer blocks are used intensively in a variety of industrial and personal applications. A brief description on the applications is presented. The physical properties of more simple model systems ...... or lamellar nature. Shear has major effect on the crystalline texture, but seems not to change the thermodynamic stable phases significantly. (C) 2001 Elsevier Science B.V. All rights reserved.......Non-ionic block copolymer systems based on hydrophilic poly(ethylene oxide) and more hydrophobic co-polymer blocks are used intensively in a variety of industrial and personal applications. A brief description on the applications is presented. The physical properties of more simple model systems...... of such PEG-based block copolymers in aqueous suspensions are reviewed. Based on scattering experiments using either X-ray or neutrons, the phase behavior is characterized, showing that the thermo-reversible gelation is a result of micellar ordering into mesoscopic crystalline phases of cubic, hexagonal...

  20. Natural convection through enclosed disconnected solid blocks

    Energy Technology Data Exchange (ETDEWEB)

    Lao, Fernando Cesar De; Junqueira, Silvio L.M.; Franco, Admilson T. [Universidade Tecnologica Federal do Parana (UTFPR), Curitiba, PR (Brazil)]. E-mails: fernandodelai@gmail.com; silvio@utfpr.edu.br; admilson@utfpr.edu.br; Lage, Jose L. [Southern Methodist University (SMU), Dallas, TX (United States)]. E-mail: JLL@smu.edu

    2008-07-01

    In this study, the natural convection inside a fluid filled, enclosure containing several solid obstructions and being heated from the side is modeled and numerically simulated. The solid obstructions are equally spaced, conducting, and disconnected square blocks. The mathematical model is based on the balance equations of mass, momentum and energy, which are then solved numerically via the finite-volume method with the SIMPLEST algorithm and the HYBRID scheme. The effects of varying the solid-fluid thermal conductivity ratio (K), the fluid volume-fraction or porosity ({phi}), the number of solid blocks (N) and the heating strength (represented by the Rayleigh number, Ra) of the enclosure on the Nusselt number based on the surface-averaged heat transfer coefficient along the heated wall of the enclosure are studied. The results indicate a competing effect caused by the proximity of the solid blocks to the heated and cooled walls, vis-a-vis hindering the boundary layer growth, hence reducing the heat transfer effectiveness, and at the same time enhancing the heat transfer when the blocks' thermal conductivity is larger than that of the fluid. An analytical estimate of the minimum number of blocks beyond which the convection hindrance becomes predominant is presented and validated by the numerical results. (author)

  1. Chain exchange in block copolymer micelles

    Science.gov (United States)

    Lu, Jie; Bates, Frank; Lodge, Timothy

    2014-03-01

    Block copolymer micelles are aggregates formed by self-assembly of amphiphilic copolymers dispersed in a selective solvent, driven by unfavorable interactions between the solvent and the core-forming block. Due to the relatively long chains being subject to additional thermodynamic and dynamic constraints (e.g., entanglements, crystallinity, vitrification), block copolymer micelles exhibit significantly slower equilibration kinetics than small molecule surfactants. As a result, details of the mechanism(s) of equilibration in block copolymer micelles remain unclear. This present works focuses on the chain exchange kinetics of poly(styrene-b-ethylenepropylene) block copolymers in squalane (C30H62) using time-resolved small angle neutron scattering (TR-SANS). A mixture of h-squalane and d-squalane is chosen so that it contrast matches a mixed 50/50 h/d polystyrene micelle core. When the temperature is appropriate and isotopically labeled chains undergo mixing, the mean core contrast with respect to the solvent decreases, and the scattering intensity is therefore reduced. This strategy allows direct probing of chain exchange rate from the time dependent scattering intensity I(q, t).

  2. Functional aspects of His bundle physiology and pathophysiology: Clinical implications.

    Science.gov (United States)

    Scherlag, Benjamin J; Lazzara, Ralph

    In this review we present evidence from many experimental studies which challenge the concept of predestination of His bundle fibers. Using both intra- and extracellular His bundle pacing in the context of atrio-ventricular block and the development of bundle branch blocks these experimental studies provide the underlying mechanisms for the recent clinical findings showing the benefits of permanent His bundle pacing. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Steroid pulse therapy was effective for cardiac sarcoidosis with ventricular tachycardia and systolic dysfunction

    OpenAIRE

    Okabe, Toshitaka; Yakushiji, Tadayuki; Hiroe, Michiaki; Oyama, Yuji; Igawa, Wataru; Ono, Morio; Kido, Takehiko; Ebara, Seitaro; Yamashita, Kennosuke; Yamamoto, Myong Hwa; Saito, Shigeo; Hoshimoto, Koichi; Kisaki, Amemiya; Isomura, Naoei; Araki, Hiroshi

    2016-01-01

    Abstract A 32?year?old man presented with palpitation. He was diagnosed with pulmonary sarcoidosis by lung biopsy. The electrocardiogram showed first?degree atrioventricular block and complete right bundle branch block (CRBBB). We planned to examine laboratory data, echocardiography, Holter monitoring, and gallium?67 scintigraphy. Before he went through all these exams, he developed ventricular tachycardia. After defibrillation was performed, his electrocardiogram revealed complete atrioventr...

  4. GEOMECHANICAL OBSERVATIONS DURING THE LARGE BLOCK TEST

    Energy Technology Data Exchange (ETDEWEB)

    STEPHEN C. BLAIR AND STEPHANIE A. WOOD

    1998-04-10

    This paper presents an overview of the geomechanical studies conducted at the Large Block Test at Fran Ridge, near Yucca Mountain, Nevada. The 3-dimensional geomechanical response of the rock to heating is being monitored using instrumentation mounted in boreholes and on the surface of the block. Results show that thermal expansion of the block began a few hours after the start of heating, and is closely correlated with the thermal history. Horizontal expansion increases as a linear function of height. Comparison of observed deformations with continuum simulations shows that below the heater plane deformation is smaller than predicted, while above the heater plane, observed deformation is larger than predicted, and is consistent with opening of vertical fractures. Fracture monitors indicate that movement on a large horizontal fracture is associated with hydrothermal behavior.

  5. Rapid ordering of block copolymer thin films.

    Science.gov (United States)

    Majewski, Pawel W; Yager, Kevin G

    2016-10-12

    Block-copolymers self-assemble into diverse morphologies, where nanoscale order can be finely tuned via block architecture and processing conditions. However, the ultimate usage of these materials in real-world applications may be hampered by the extremely long thermal annealing times-hours or days-required to achieve good order. Here, we provide an overview of the fundamentals of block-copolymer self-assembly kinetics, and review the techniques that have been demonstrated to influence, and enhance, these ordering kinetics. We discuss the inherent tradeoffs between oven annealing, solvent annealing, microwave annealing, zone annealing, and other directed self-assembly methods; including an assessment of spatial and temporal characteristics. We also review both real-space and reciprocal-space analysis techniques for quantifying order in these systems.

  6. Can neural blocks prevent phantom limb pain?

    Science.gov (United States)

    Borghi, Battista; D'Addabbo, Marco; Borghi, Raffaele

    2014-07-01

    Phantom limb syndrome (PLS) is a syndrome including stump pain, phantom limb pain and not-painful phantom sensations, which involves a large part of amputee patients and often has devastating effects on their quality of life. The efficacy of standard therapies is very poor. Nerve blocks have been investigated for the treatment and prevention of PLS. Epidural and peripheral blocks limited to the first three postamputation days can only reduce acute pain but cannot prevent the later development of PLS. Recent studies have shown that ambulatory prolonged peripheral nerve block (up to 30 days postamputation) may represent a new possible option to treat phantom pain and prevent the development of PLS and chronic pain.

  7. Thoracal paravertebral block for breast surgery

    Directory of Open Access Journals (Sweden)

    Serbülent Gökhan Beyaz

    2012-12-01

    Full Text Available Thoracic paravertebral block (TPVB is an alternativemethod to general anesthesia because of provides a safeanesthesia with balanced hemodynamic response, allowspostoperative pain control by means of catheter and haslow side effect profile. TPVB performed safely for the patientsundergoing breast cancer surgery with the samereason, has used in too few center instead of general anesthesia.This technique provides an adequate anesthesiafor the patients undergoing breast surgery and in additionprovides stable hemodynamic status with unilateralsomatic and sympathetic blockade, near-perfect controlof postoperative pain, minimal nausea and vomiting rate,early discharge and low cost. For this reason, thoracicparavertebral block which is a standard method in breastsurgeries for some centers should be known by all anesthesiologists.We believe that, thoracic paravertebralblock is a method can be applied instead of general anesthesia.Key words: Paravertebral block, thoracic, breast surgery,regional anesthesia

  8. Concentration Dependent Structure of Block Copolymer Solutions

    Science.gov (United States)

    Choi, Soohyung; Bates, Frank S.; Lodge, Timothy P.

    2015-03-01

    Addition of solvent molecules into block copolymer can induce additional interactions between the solvent and both blocks, and therefore expands the range of accessible self-assembled morphologies. In particular, the distribution of solvent molecules plays a key role in determining the microstructure and its characteristic domain spacing. In this study, concentration dependent structures formed by poly(styrene-b-ethylene-alt-propylene) (PS-PEP) solution in squalane are investigated using small-angle X-ray scattering. This reveals that squalane is essentially completely segregated into the PEP domains. In addition, the conformation of the PS block changes from stretched to nearly fully relaxed (i.e., Gaussian conformation) as amounts of squalane increases. NRF

  9. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block

    NARCIS (Netherlands)

    Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.

    Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral

  10. Production blocking and idea generation : Does blocking interfere with cognitive processes?

    NARCIS (Netherlands)

    Nijstad, BA; Stroebe, W; Lodewijkx, HFM

    2003-01-01

    Production blocking (group members must take turns expressing their ideas) is an important cause of productivity loss in brainstorming groups. However, it is not yet clear why production blocking has this detrimental effect. We hypothesized that delays between the generation and articulation of

  11. Lidocaine block of cardiac sodium channels.

    Science.gov (United States)

    Bean, B P; Cohen, C J; Tsien, R W

    1983-05-01

    Lidocaine block of cardiac sodium channels was studied in voltage-clamped rabbit purkinje fibers at drug concentrations ranging from 1 mM down to effective antiarrhythmic doses (5-20 muM). Dose-response curves indicated that lidocaine blocks the channel by binding one-to-one, with a voltage-dependent K(d). The half-blocking concentration varied from more than 300 muM, at a negative holding potential where inactivation was completely removed, to approximately 10 muM, at a depolarized holding potential where inactivation was nearly complete. Lidocaine block showed prominent use dependence with trains of depolarizing pulses from a negative holding potential. During the interval between pulses, repriming of I (Na) displayed two exponential components, a normally recovering component (tauless than 0.2 s), and a lidocaine-induced, slowly recovering fraction (tau approximately 1-2 s at pH 7.0). Raising the lidocaine concentration magnified the slowly recovering fraction without changing its time course; after a long depolarization, this fraction was one-half at approximately 10 muM lidocaine, just as expected if it corresponded to drug-bound, inactivated channels. At less than or equal to 20 muM lidocaine, the slowly recovering fraction grew exponentially to a steady level as the preceding depolarization was prolonged; the time course was the same for strong or weak depolarizations, that is, with or without significant activation of I(Na). This argues that use dependence at therapeutic levels reflects block of inactivated channels, rather than block of open channels. Overall, these results provide direct evidence for the "modulated-receptor hypothesis" of Hille (1977) and Hondeghem and Katzung (1977). Unlike tetrodotoxin, lidocaine shows similar interactions with Na channels of heart, nerve, and skeletal muscle.

  12. Block Copolymer Adhesion Promoter: Effect of Non Adsorbing Block Length and Substrate Polarity

    Science.gov (United States)

    Costa, Ana Claudia; Composto, Russell J.; Vlcek, Petr; Satija, Sushil; Ivkov, Robert

    2001-03-01

    Block copolymer adsorption to polar substrates is investigated using neutron reflectivity and forward recoil spectrometry. The adhesion promoter is poly (deuterated styrene-block-methylmethacrylate) (dPS-b-MMA) having a short and nearly constant MMA block, which adsorbs to the substrate. The non-adsorbing dPS block length, NdPS, is systematically varied from below to above the entanglement degree of polymerization (Ne). The dPS-b-MMA is blended with a PS matrix, which represents a nearly neutral environment for the dPS block. The substrates are silicon oxide and an organic monolayer of an amino terminated silane. Dewetting studies show that film stability increases as NdPS approaches Ne and as the substrate becomes more hydrophobic. These macroscopic results suggest that entanglements across the matrix/adsorbed layer interface and a strong MMA-substrate interaction can greatly improve thin film stability.

  13. Role of corona block in molecular exchange in block copolymer micelles

    Science.gov (United States)

    Wang, En; Lu, Jie; Lodge, Timothy; Bates, Frank

    Self-assembled block polymer micelles are used in a variety of applications including drug delivery and viscosity modification as additives to motor lubricants. Previous work with dilute solutions of poly(styrene-b-ethylene-alt-propylene) (PS-PEP) diblock copolymer micelle has resulted in a theoretical model that accounts for the dramatic influence of the PS core block length and dispersity on chain exchange kinetics in squalane, a selective neutral solvent for PEP. This model, which accounts for the significant effect of core block length and its polydispersity on chain exchange kinetics, does not address the role of the corona block length. This presentation will describe the consequences of varying the size of the PEP corona block at constant core molecular weight on the rate of chain exchange based on time-resolved small-angle neutron scattering (TR-SANS) measurements. These results have informed an improved model that explicitly includes a corona term.

  14. Heart block following propofol in a child.

    Science.gov (United States)

    Sochala, C; Deenen, D; Ville, A; Govaerts, M J

    1999-01-01

    We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. Propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. Heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.

  15. Low-Power Blocks for UWB Transceivers

    OpenAIRE

    Kim, Joshua H.

    2014-01-01

    In this dissertation, low-power blocks in UWB transceiver systems are presented. In particular, the main focus of this study is how low-power blocks in an impulse radio UWB (IR-UWB) system can be employed in sensor networks such as Body Area Networks (BANs). The thesis is divided into three general parts. In the first part, the general history, definitions, regulations, and development of UWB systems are reviewed. In addition, a brief explanation of the fundamental concepts of radio freq...

  16. Block floating point for radar data

    DEFF Research Database (Denmark)

    Christensen, Erik Lintz

    1999-01-01

    Integer, floating point, and block floating point (BFP) data formats are analyzed and compared in order to establish the mathematical tools for selection of an optimal format which fulfils the demands of high resolution radar (SAR) data to large dynamic range and adequate S/N. The analysis takes...... quantization noise and saturation distortion into account and concludes that it is preferred to use small blocks and a (new) modified BFP format applying fractional exponents. Data from the EMISAR radar system are applied to illustrate the merits of the different schemes....

  17. Ophthalmic regional blocks: management, challenges, and solutions

    Directory of Open Access Journals (Sweden)

    Palte HD

    2015-08-01

    Full Text Available Howard D Palte Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL, USA Abstract: In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon’s block has gained popularity while the deep angulated intraconal (retrobulbar block has been largely superseded by the shallower extraconal (peribulbar approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it

  18. Identification of critical technology building blocks

    DEFF Research Database (Denmark)

    Ravn, Poul Martin; Mortensen, Niels Henrik; Hvam, Lars

    2017-01-01

    In order to have a better base for decisions, R&D managers need to know what the critical areas of development are in relation to the technologies they develop, mature, and include in the portfolio. As most of the technologies in a company have the potential to have a significant impact on compet......, and using property chains to identify critical technology building blocks....... on competition, the challenge is to know how to identify and prioritize the development tasks. If possible, an effective strategy can be defined. This article suggests a framework for identification and analysis of a product portfolio, with special emphasis on identifying critical technology building blocks...

  19. Wilson loop invariants from WN conformal blocks

    Directory of Open Access Journals (Sweden)

    Oleg Alekseev

    2015-12-01

    Full Text Available Knot and link polynomials are topological invariants calculated from the expectation value of loop operators in topological field theories. In 3D Chern–Simons theory, these invariants can be found from crossing and braiding matrices of four-point conformal blocks of the boundary 2D CFT. We calculate crossing and braiding matrices for WN conformal blocks with one component in the fundamental representation and another component in a rectangular representation of SU(N, which can be used to obtain HOMFLY knot and link invariants for these cases. We also discuss how our approach can be generalized to invariants in higher-representations of WN algebra.

  20. A Variable Block Insertion Heuristic for the Blocking Flowshop Scheduling Problem with Total Flowtime Criterion

    Directory of Open Access Journals (Sweden)

    Mehmet Fatih Tasgetiren

    2016-10-01

    Full Text Available In this paper, we present a variable block insertion heuristic (VBIH algorithm to solve the blocking flowshop scheduling problem with the total flowtime criterion. In the VBIH algorithm, we define a minimum and a maximum block size. After constructing the initial sequence, the VBIH algorithm starts with a minimum block size being equal to one. It removes the block from the current sequence and inserts it into the partial sequence sequentially with a predetermined move size. The sequence, which is obtained after several block moves, goes under a variable local search (VLS, which is based on traditional insertion and swap neighborhood structures. If the new sequence obtained after the VLS local search is better than the current sequence, it replaces the current sequence. As long as it improves, it keeps the same block size. However, if it does not improve, the block size is incremented by one and a simulated annealing-type of acceptance criterion is used to accept the current sequence. This process is repeated until the block size reaches at the maximum block size. Furthermore, we present a novel constructive heuristic, which is based on the profile fitting heuristic from the literature. The proposed constructive heuristic is able to further improve the best known solutions for some larger instances in a few seconds. Parameters of the constructive heuristic and the VBIH algorithm are determined through a design of experiment approach. Extensive computational results on the Taillard’s well-known benchmark suite show that the proposed VBIH algorithm outperforms the discrete artificial bee colony algorithm, which is one of the most efficient algorithms recently in the literature. Ultimately, 52 out of the 150 best known solutions are further improved with substantial margins.

  1. quality assessment of sandcrete blocks produced in adeta, kwara ...

    African Journals Online (AJOL)

    HOD

    each soil samples collected from the eight (8) Block. Industries investigated in this research. The results obtained for the eight (8) Block factories fall below the range of 2.6 to 2.7 specified for natural aggregates by. Neville [15]. The mix ratios adopted by the eight (8) block factories in the production of their blocks is shown in ...

  2. 30 CFR 250.611 - Traveling-block safety device.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Traveling-block safety device. 250.611 Section... Traveling-block safety device. After May 31, 1989, all units being used for well-workover operations which have both a traveling block and a crown block shall be equipped with a safety device which is designed...

  3. 30 CFR 250.511 - Traveling-block safety device.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Traveling-block safety device. 250.511 Section... Traveling-block safety device. All units being used for well-completion operations that have both a traveling block and a crown block must be equipped with a safety device that is designed to prevent the...

  4. Application of multi-block methods in cement production

    DEFF Research Database (Denmark)

    Svinning, K.; Høskuldsson, Agnar

    2008-01-01

    distribution and the two last blocks the superficial microstructure analysed by differential thermo gravimetric analysis. The multi-block method is used to identify the role of each part. The score vectors of each block can be analysed separately or together with score vectors of other blocks. Stepwise...

  5. Heparin-containing block copolymers; Part I: Surface characterization

    NARCIS (Netherlands)

    Vulić, I.; Pijpers, A.P.; Okano, T.; Kim, S.W.; Feijen, Jan

    1993-01-01

    Newly synthesized heparin-containing block copolymers, consisting of a hydrophobic block of polystyrene (PS), a hydrophilic spacer-block of poly(ethylene oxide) (PEO) and covalently bound heparin (Hep) as bioactive block, were coated on aluminium, glass, polydimethylsiloxane (PDMS), PS or Biomer

  6. Fouling layer characterization and pore-blocking mechanisms in an ...

    African Journals Online (AJOL)

    Regarding pore-blocking mechanisms, standard blocking was the predominant mechanism at the beginning of filtration, coexisting at the end of it with cake filtration. In the first filtration cycle (1 h), after standard blocking, intermediate and complete blocking developed simultaneously during a short period of time and, finally, ...

  7. Improving Parent-Child Relationships through Block Play

    Science.gov (United States)

    Lin, Yen-Chun

    2010-01-01

    Blocks are one of the most popular playthings for children. The purpose of this article is to describe the use of block play in developing parent-child relations. This paper has two major parts. First, a brief historical overview highlights the critical roles of child's block play in learning and development. Block play contributes to children's…

  8. Building Blocks for Young Children's Mathematical Development.

    Science.gov (United States)

    Sarama, Julie; Clements, Douglas H.

    2002-01-01

    Describes the design principles behind a set of research-based software microworlds included in the "Building Blocks" program, a pre-kindergarten to grade 2 software-based mathematics curriculum. Discusses how to help children extend and mathematize their everyday activities and presents the nine-step design process model used.…

  9. Charge Transport in Conjugated Block Copolymers

    Science.gov (United States)

    Smith, Brandon; Le, Thinh; Lee, Youngmin; Gomez, Enrique

    Interest in conjugated block copolymers for high performance organic photovoltaic applications has increased considerably in recent years. Polymer/fullerene mixtures for conventional bulk heterojunction devices, such as P3HT:PCBM, are severely limited in control over interfaces and domain length scales. In contrast, microphase separated block copolymers self-assemble to form lamellar morphologies with alternating electron donor and acceptor domains, thereby maximizing electronic coupling and local order at interfaces. Efficiencies as high as 3% have been reported in solar cells for one block copolymer, P3HT-PFTBT, but the details concerning charge transport within copolymers have not been explored. To fill this gap, we probed the transport characteristics with thin-film transistors. Excellent charge mobility values for electron transport have been observed on aluminum source and drain contacts in a bottom gate, bottom contact transistor configuration. Evidence of high mobility in ordered PFTBT phases has also been obtained following thermal annealing. The insights gleaned from our investigation serve as useful guideposts, revealing the significance of the interplay between charge mobility, interfacial order, and optimal domain size in organic block copolymer semiconductors.

  10. Restructuring in block copolymer thin films

    DEFF Research Database (Denmark)

    Posselt, Dorthe; Zhang, Jianqi; Smilgies, Detlef-M.

    2017-01-01

    Block copolymer (BCP) thin films have been proposed for a number of nanotechnology applications, such as nanolithography and as nanotemplates, nanoporous membranes and sensors. Solvent vapor annealing (SVA) has emerged as a powerful technique for manipulating and controlling the structure of BCP ...

  11. Seizure complicating interscalene brachail plexus block | Idehen ...

    African Journals Online (AJOL)

    We describe a case of seizure occurring immediately after completion of interscalene brachial plexus block, using 20mls mixture of 10mls of 0.5% bupivacaine and 10mls of 2% lidocaine with adrenaline for post operative analgesia. Seizure occurred despite negative test aspiration and non response to the use of 0.5mls of ...

  12. Nerve injury caused by mandibular block analgesia

    DEFF Research Database (Denmark)

    Hillerup, S; Jensen, Rigmor H

    2006-01-01

    Fifty-four injection injuries in 52 patients were caused by mandibular block analgesia affecting the lingual nerve (n=42) and/or the inferior alveolar nerve (n=12). All patients were examined with a standardized test of neurosensory functions. The perception of the following stimuli was assessed:...

  13. Colour Blocking: Disregarding Traditional Artistic Colour Harmonies ...

    African Journals Online (AJOL)

    A development in the world of design – costume, fashion, graphics, architecture and general decor whereby traditional colour harmonies are reengineered to suite the taste of the time engages the attention of the paper. The trending phenomenon popularly referred to as 'colour blocking' involves the use of bright ...

  14. Nylon 46-polytetramethylene oxide segmented block copolymers

    NARCIS (Netherlands)

    Gaymans, R.J.; Schwering, P.; de Haan, J.L.

    1989-01-01

    Block copolymers were synthesized from amine-terminated polytetramethylene oxide (PMTO) (Mw 800 and 1130) and polyamide 4,6 salt. First prepolymers were prepared at 200–210°C in the presence of a solvent (pyrrolidone). The prepolymers were postcondensed at 255°C (where possible in the solid state)

  15. Cervical plexus block for thyroidectomy | Kolawole | Southern ...

    African Journals Online (AJOL)

    Objective: Thyroidectomy is traditionally performed under general anaesthesia with endotracheal intubation. However, cervical plexus block has also been found useful for this operation in some parts of the world. This particular anaesthetic option has never been reported in our environment. The aims of this study were to ...

  16. Preparation of amphiphilic block copolymer containing triazene ...

    Indian Academy of Sciences (India)

    The lower rate constant in film state (film = 1.3 × 10−3 s-1), shows that the higher mobility of polymeric chains in solution allow a more rapid orientation, favourable to the triazene bond cleavage. The capability of block copolymer to form micelles in aqueous environment and implicitly, its critical micelle concentration (CMC) ...

  17. Tough and Sustainable Graft Block Copolymer Thermoplastics

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Jiuyang; Li, Tuoqi; Mannion, Alexander M.; Schneiderman, Deborah K.; Hillmyer, Marc A.; Bates, Frank S. (UMM)

    2016-03-15

    Fully sustainable poly[HPMC-g-(PMVL-b-PLLA)] graft block copolymer thermoplastics were prepared from hydroxypropyl methylcellulose (HPMC), β-methyl-δ-valerolactone (MVL), and l-lactide (LLA) using a facile two-step sequential addition approach. In these materials, rubbery PMVL functions as a bridge between the semirigid HPMC backbone and the hard PLLA end blocks. This specific arrangement facilitates PLLA crystallization, which induces microphase separation and physical cross-linking. By changing the backbone molar mass or side chain composition, these thermoplastic materials can be easily tailored to access either plastic or elastomeric behavior. Moreover, the graft block architecture can be utilized to overcome the processing limitations inherent to linear block polymers. Good control over molar mass and composition enables the deliberate design of HPMC-g-(PMVL-b-PLLA) samples that are incapable of microphase separation in the melt state. These materials are characterized by relatively low zero shear viscosities in the melt state, an indication of easy processability. The simple and scalable synthetic procedure, use of inexpensive and renewable precursors, and exceptional rheological and mechanical properties make HPMC-g-(PMVL-b-PLLA) polymers attractive for a broad range of applications.

  18. Improved cryptanalysis of the block cipher KASUMI

    DEFF Research Database (Denmark)

    Jia, Keting; Li, Leibo; Rechberger, Christian

    2013-01-01

    KASUMI is a block cipher which consists of eight Feistel rounds with a 128-bit key. Proposed more than 10 years ago, the confidentiality and integrity of 3G mobile communications systems depend on the security of KASUMI. In the practically interesting single key setting, only up to 6 rounds have ...

  19. Kinematics and mechanics of tectonic block rotations

    Science.gov (United States)

    Nur, Amos; Scotti, Oona; Ron, Hagai

    1989-01-01

    Paleomagnetic, structural geology, and rock mechanics data are combined to explore the validity of the block rotation concept and its significance. The analysis is based on data from (1) Northern Israel, where fault slip and spacing are used to predict block rotation; (2) the Mojave Desert, with well-documented strike-slip fault sets, organized in at least three major domains; (3) the Lake Mead, Nevada, fault system with well-defined sets of strike-slip faults, which, in contrast to the Mojave region, are surrounded with domains of normal faults; and (4) the San Gabriel Mountains domain with a multiple set of strike-slip faults. It is found that block rotations can have a profound influence on the interpretation of geodetic measurements and the inversion of geodetic data, especially the type collected in GPS surveys. Furthermore, block rotations and domain boundaries may be involved in creating the heterogeneities along active fault systems which are responsible for the initiation and termination of earthquake rupture.

  20. Beta-blocking agents with vasodilating action.

    Science.gov (United States)

    Prichard, B N

    1992-01-01

    beta-Adrenoceptor-blocking drugs in current use can be separated into two main groups: those nonselective and those selective for beta 1-receptors. Members of each group reduce cardiac output and lead to an increase in peripheral resistance with a concomitant reduction in blood flow. beta-Blocking drugs not only may occupy the receptor preventing stimulation but also may have intrinsic sympathomimetic activity. Those with marked partial agonist activity at the beta 2-receptor giving some beta 2-mediated vasodilation can be regarded as the first multiple-action beta-blocking drugs. Subsequently, drugs have been developed that in addition to blocking the beta-receptor have an important peripheral vasodilator activity. Labetalol was the first drug of this group to be developed; prizidolol followed but has been withdrawn because of toxicity. Several other agents have been described, including bucindolol, carvedilol, celiprolol, dilevalol (one of the isomers of labetalol), and medroxolol. Three mechanisms have been reported to be responsible for peripheral vasodilation: alpha-receptor blockade, beta 2-agonism, and a dilator action independent of either the alpha- or beta-receptors. Evidence for these various mechanisms is more readily obtainable from animal experiments, but some confirmatory evidence has been obtained in humans. Inhibition of alpha-stimulation had been found with labetalol, medroxalol, and carvedilol and suggested with celiprolol. beta 2-Mediated vasodilation has been demonstrated by, for example, celiprolol and dilevalol; evidence of a vasodilation independent of alpha-blockade or beta 2-stimulation has been reported with celiprolol and carvedilol.

  1. Blocked atrial bigeminy presenting with bradycardia.

    Science.gov (United States)

    Akdeniz, Celal; Tanidir, Ibrahim Cansaran; Tuzcu, Volkan

    2012-01-01

    Blocked premature atrial contractions can cause bradycardia by resetting sinoatrial node and prolonging the RR intervals. Herein, we report the management of a patient with frequent premature atrial contractions in bigeminal pattern. The patient presented with symptomatic bradycardia and was successfully treated with propafenone. © 2012 Wiley Periodicals, Inc.

  2. Blocking Losses With a Photon Counter

    Science.gov (United States)

    Moision, Burce E.; Piazzolla, Sabino

    2012-01-01

    It was not known how to assess accurately losses in a communications link due to photodetector blocking, a phenomenon wherein a detector is rendered inactive for a short time after the detection of a photon. When used to detect a communications signal, blocking leads to losses relative to an ideal detector, which may be measured as a reduction in the communications rate for a given received signal power, or an increase in the signal power required to support the same communications rate. This work involved characterizing blocking losses for single detectors and arrays of detectors. Blocking may be mitigated by spreading the signal intensity over an array of detectors, reducing the count rate on any one detector. A simple approximation was made to the blocking loss as a function of the probability that a detector is unblocked at a given time, essentially treating the blocking probability as a scaling of the detection efficiency. An exact statistical characterization was derived for a single detector, and an approximation for multiple detectors. This allowed derivation of several accurate approximations to the loss. Methods were also derived to account for a rise time in recovery, and non-uniform illumination due to diffraction and atmospheric distortion of the phase front. It was assumed that the communications signal is intensity modulated and received by an array of photon-counting photodetectors. For the purpose of this analysis, it was assumed that the detectors are ideal, in that they produce a signal that allows one to reproduce the arrival times of electrons, produced either as photoelectrons or from dark noise, exactly. For single detectors, the performance of the maximum-likelihood (ML) receiver in blocking is illustrated, as well as a maximum-count (MC) receiver, that, when receiving a pulse-position-modulated (PPM) signal, selects the symbol corresponding to the slot with the largest electron count. Whereas the MC receiver saturates at high count rates

  3. The fusion band in V1: a simple ECG guide to optimal resynchronization? An echocardiographic case report

    Directory of Open Access Journals (Sweden)

    Corbucci Giorgio

    2005-09-01

    Full Text Available Abstract Background Patients with left bundle branch block have a preserved right bundle branch conduction and the efficacy of left ventricular pacing could be explained with the fusion between artificial pulse delivered in the left lateral wall and the spontaneous right ventricular activation. Moreover, the efficacy of left ventricular pacing could be enhanced with an optimal timing between the spontaneous right ventricular activation and the left ventricular pulse. Case presentation We evaluated a patient (male, 47 yrs with surgically corrected mitral regurgitation, sinus rhythm and left bundle branch block, heart failure (NYHA class III despite medical therapy and low ejection fraction (25%: he was implanted with a biventricular device. We programmed ventricular pacing only through the left ventricular lead. We defined what we called electrocardiographic "fusion band" as follow: programming OFF the stimulator, we recorded the native electrocardiogram and measured, through the device, the intrinsic atrioventricular interval. Then, atrioventricular interval was progressively shortened by steps of 20 ms down to 100 ms. Twelve leads electrocardiogram was recorded at each step. The fusion band is the range of AV intervals at which surface electrocardiogram (mainly in V1 lead presents an intermediate morphology between the native left bundle branch block (upper limit of the band and the fully paced right bundle branch block (lower limit. The patient underwent echocardiographic examination at each atrioventricular interval chosen inside the fusion band. The following parameters were evaluated: ejection fraction, diastolic filling time, E wave deceleration time, aortic velocity time integral and myocardial performance index. All the echocardiographic parameters showed an improvement inside the fusion band, with a "plateau" behaviour. As the fusion band in this patient ranged from an atrioventricular delay of 200 ms to an atrioventricular delay of 120

  4. eBLOCKs: enumerating conserved protein blocks to achieve maximal sensitivity and specificity

    Science.gov (United States)

    Su, Qiaojuan Jane; Lu, Lin; Saxonov, Serge; Brutlag, Douglas L.

    2005-01-01

    Classifying proteins into families and superfamilies allows identification of functionally important conserved domains. The motifs and scoring matrices derived from such conserved regions provide computational tools that recognize similar patterns in novel sequences, and thus enable the prediction of protein function for genomes. The eBLOCKs database enumerates a cascade of protein blocks with varied conservation levels for each functional domain. A biologically important region is most stringently conserved among a smaller family of highly similar proteins. The same region is often found in a larger group of more remotely related proteins with a reduced stringency. Through enumeration, highly specific signatures can be generated from blocks with more columns and fewer family members, while highly sensitive signatures can be derived from blocks with fewer columns and more members as in a superfamily. By applying PSI-BLAST and a modified K-means clustering algorithm, eBLOCKs automatically groups protein sequences according to different levels of similarity. Multiple sequence alignments are made and trimmed into a series of ungapped blocks. Motifs and position-specific scoring matrices were derived from eBLOCKs and made available for sequence search and annotation. The eBLOCKs database provides a tool for high-throughput genome annotation with maximal specificity and sensitivity. The eBLOCKs database is freely available on the World Wide Web at http://motif.stanford.edu/eblocks/ to all users for online usage. Academic and not-for-profit institutions wishing copies of the program may contact Douglas L. Brutlag (brutlag@stanford.edu). Commercial firms wishing copies of the program for internal installation may contact Jacqueline Tay at the Stanford Office of Technology Licensing (jacqueline.tay@stanford.edu; http://otl.stanford.edu/). PMID:15608172

  5. On the Marginal Distribution of the Diagonal Blocks in a Blocked Wishart Random Matrix

    Directory of Open Access Journals (Sweden)

    Kjetil B. Halvorsen

    2016-01-01

    Full Text Available Let A be a (m1+m2×(m1+m2 blocked Wishart random matrix with diagonal blocks of orders m1×m1 and m2×m2. The goal of the paper is to find the exact marginal distribution of the two diagonal blocks of A. We find an expression for this marginal density involving the matrix-variate generalized hypergeometric function. We became interested in this problem because of an application in spatial interpolation of random fields of positive definite matrices, where this result will be used for parameter estimation, using composite likelihood methods.

  6. Solving block linear systems with low-rank off-diagonal blocks is easily parallelizable

    Energy Technology Data Exchange (ETDEWEB)

    Menkov, V. [Indiana Univ., Bloomington, IN (United States)

    1996-12-31

    An easily and efficiently parallelizable direct method is given for solving a block linear system Bx = y, where B = D + Q is the sum of a non-singular block diagonal matrix D and a matrix Q with low-rank blocks. This implicitly defines a new preconditioning method with an operation count close to the cost of calculating a matrix-vector product Qw for some w, plus at most twice the cost of calculating Qw for some w. When implemented on a parallel machine the processor utilization can be as good as that of those operations. Order estimates are given for the general case, and an implementation is compared to block SSOR preconditioning.

  7. COMPARISON OF UNILATERAL PARAVERTEBRAL BLOCK WITH SUBARACHNOID BLOCK FOR POSTOPERATIVE ANALGESIA IN UNILATERAL INGUINAL HERNIA SURGERIES

    Directory of Open Access Journals (Sweden)

    Girish Sharma

    2017-10-01

    Full Text Available BACKGROUND Paravertebral Block (PVB is emerging as an alternative anaesthesia technique for inguinal hernia repair with some advantages over Subarachnoid Block (SAB. This study compares unilateral paravertebral block with subarachnoid block for postoperative analgesia in unilateral inguinal hernia surgeries. The aim of the study is to study the comparison of Paravertebral Block (PVB with Subarachnoid Block (SAB for postoperative pain at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours in unilateral inguinal hernia surgeries. The onset and extent of sensory and motor block, time to ambulation and patient and surgeon comfort level were also assessed. MATERIALS AND METHODS Sixty adult male patients, aged 18-65 years with American Society of Anaesthesiologist (ASA grade I and II presenting for unilateral inguinal hernia repair over a period of one year were allocated into two groups to receive SAB (Group I, 2.5 cc of 0.5% bupivacaine with clonidine 30 µg at L3-4 level or PVB (Group II, 30 mL of 0.25% bupivacaine and clonidine 30 µg given at T10, T12 and L2 level. The primary objective was to assess postoperative pain scores on Visual Analogue Scale (VAS of 0- 10 at 0, 1, 2, 4, 6, 12 and 24 hours and analgesic requirement in first 24 hours after surgery. Secondary objectives were to compare onset and depth of sensory and motor block, intraoperative haemodynamic, patient and surgeon comfort level and time for ambulation were also recorded. RESULTS Onset of sensory block was faster in Group I (4.5 ± 0.5 vs. 13.1 ± 0.6 mins. in Group II (P value ˂0.001. PVB had advantage of limited extent of sensory and motor block (T8 to L3 as compared to T6 to S5 in Group I. Postoperative Visual Analogue Scale (VAS was lower in Group II at 4, 6 and 12 hours (P value ˂0.001. The mean consumption of diclofenac sodium in first 24 hours in Group I was 72.5 mg while in Group II was 7.5 mg (P value ˂0.001. Patient (76.6% vs. 56.6% and

  8. Adrenoceptor blocking effects of arotinolol, a new combined alpha- and beta-adrenoceptor blocking agent.

    Science.gov (United States)

    Miyagishi, A; Nakahara, H; Hara, Y

    1984-10-01

    In isolated tissues and anesthetized animals, beta- and alpha-adrenoceptor blocking properties of arotinolol were studied in comparison with those of other typical adrenoceptor antagonists. The following order of beta-adrenoceptor blocking activities were obtained in isolated tissues: arotinolol = pindolol greater than propranolol = oxprenolol = alprenolol greater than or equal to labetalol for beta 1-adrenoceptors (guinea-pig right atrium) and pindolol = oxprenolol = arotinolol greater than propranolol greater than labetalol for beta 2-adrenoceptors (guinea-pig trachea). In anesthetized cats, arotinolol was about 9 and 25 times more potent than propranolol, about 30 and 100 times more potent than labetalol in blocking beta 1- and beta 2-adrenoceptors, respectively. Furthermore arotinolol showed a competitive antagonistic effect on phenylephrine-induced contraction of isolated rat aortic strips. The relative order of alpha 1-adrenoceptor blocking potencies was as follows: prazosin greater than phentolamine greater than labetalol greater than arotinolol = yohimbine. Presynaptic alpha 2-adrenoceptor blocking action of arotinolol was also assessed in isolated rat vas deferens and arotinolol was revealed to be a much weaker presynaptic alpha 2-adrenoceptor antagonist. In anesthetized rats arotinolol was 4-5 times less potent than labetalol and about 26 times less potent than phentolamine in blocking alpha 1-adrenoceptors. Thus, as for the selectivity for 2 subtypes of alpha-adrenoceptors, arotinolol showed a selectivity for alpha 1-adrenoceptors over presynaptic alpha 2-adrenoceptors.

  9. Adductor canal block can result in motor block of the quadriceps muscle.

    Science.gov (United States)

    Chen, Junping; Lesser, Jonathan B; Hadzic, Admir; Reiss, Wojciech; Resta-Flarer, Francesco

    2014-01-01

    The block of nerves in the adductor canal is considered to cause a sensory block without a motor component. In this report, we describe a case of significant quadriceps muscle weakness after an adductor canal block (ACB). A 65-year-old female patient for ambulatory knee surgery was given an ACB for postoperative pain management. The block was performed under ultrasound guidance at the midthigh level using the transsartorial approach. Twenty milliliters of 0.5% ropivacaine was deposited adjacent to the anterior and posterior areas of the femoral artery. On discharge from the hospital, the patient realized that her thigh muscles were weak and she was unable to extend her leg at the knee. A neuromuscular examination indicated that the patient had no strength in her quadriceps muscle, along with sensory deficit in the medial-anterior lower leg and area in front of knee up to the midthigh. The weakness lasted 20 hours, and the sensory block lasted 48 hours before complete recovery. The optimal level and amount of local anesthetic for adductor canal block are currently not well defined. Proximal spread of local anesthetic and anatomical variation may explain our observation. Several studies have reported that ACB involves no motor blockade. However, our case report illustrates that the ACB can result in clinically significant quadriceps muscle paralysis. This report suggests that patients should be monitored vigilantly for this occurrence to decrease the risk of falls.

  10. Hybrid, Nanoscale Phospholipid/Block Copolymer Vesicles

    Directory of Open Access Journals (Sweden)

    Bo Liedberg

    2013-09-01

    Full Text Available Hybrid phospholipid/block copolymer vesicles, in which the polymeric membrane is blended with phospholipids, display interesting self-assembly behavior, incorporating the robustness and chemical versatility of polymersomes with the softness and biocompatibility of liposomes. Such structures can be conveniently characterized by preparing giant unilamellar vesicles (GUVs via electroformation. Here, we are interested in exploring the self-assembly and properties of the analogous nanoscale hybrid vesicles (ca. 100 nm in diameter of the same composition prepared by film-hydration and extrusion. We show that the self-assembly and content-release behavior of nanoscale polybutadiene-b-poly(ethylene oxide (PB-PEO/1-palmitoyl-2-oleoyl-sn-glycero-3-phosphatidylcholine (POPC hybrid phospholipid/block copolymer vesicles can be tuned by the mixing ratio of the amphiphiles. In brief, these hybrids may provide alternative tools for drug delivery purposes and molecular imaging/sensing applications and clearly open up new avenues for further investigation.

  11. Patients with Prion: Blocking Precautions Epidemiological

    Directory of Open Access Journals (Sweden)

    Liarine Fernandes Bedin

    2017-01-01

    Full Text Available Objective: To present the epidemiological blocking measures carried out in the hospital care of patients with Creutzfeldt-Jakob disease. Methodology: retrospective case series of four patients admitted to a referral hospital in southern Brazil, from June 2012 to June 2015. Results: Epidemiological profile: female, aged between 56 and 65anos only one with comorbid preview, all in palliative care, one death, a tall, two transfers to source hospitals. epidemiological blocking measures taken: mandatory notification of registration of CJD; standard precautions, identification and packaging materials for risk of transmission; disinfecting materials preceding sterilization; and handling of warranty and place of proper disposal of waste. Conclusions: The epidemiological control measures and resolutions regarding the management of these patients are recent. It is important that the health team appropriates the theme in order to provide proper care and quality. KEY WORDS: Prions. Creutzfeldt-Jakob Syndrome. Epidemiological Monitoring.

  12. Osmosis and thermodynamics explained by solute blocking.

    Science.gov (United States)

    Nelson, Peter Hugo

    2017-01-01

    A solute-blocking model is presented that provides a kinetic explanation of osmosis and ideal solution thermodynamics. It validates a diffusive model of osmosis that is distinct from the traditional convective flow model of osmosis. Osmotic equilibrium occurs when the fraction of water molecules in solution matches the fraction of pure water molecules that have enough energy to overcome the pressure difference. Solute-blocking also provides a kinetic explanation for why Raoult's law and the other colligative properties depend on the mole fraction (but not the size) of the solute particles, resulting in a novel kinetic explanation for the entropy of mixing and chemical potential of ideal solutions. Some of its novel predictions have been confirmed; others can be tested experimentally or by simulation.

  13. Porous polymers based on aryleneethynylene building blocks.

    Science.gov (United States)

    Bunz, Uwe H F; Seehafer, Kai; Geyer, Florian L; Bender, Markus; Braun, Ingo; Smarsly, Emanuel; Freudenberg, Jan

    2014-09-01

    Porous conjugated polymers are synthesized by metal-catalyzed coupling reactions. The progress for porous polymers when planar or tetrahedral building blocks are connected by alkyne units into novel materials is highlighted. The most prominent reaction for the buildup of the microporous alkyne-bridged polymers is the Sonogashira reaction, connecting alkynes to aromatic iodides or bromides. The availability of the building blocks and the potency of the Sonogashira reaction allow preparing a large variety of intrinsically porous polymeric materials, in which rigid struts connect multipronged centers. The microporous polymers are used as catalysts and as storage materials for gases and sensors. Postfunctionalization schemes, understanding of structure-property relationships, and the quest for high porosity are pertinent. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  14. Essential Building Blocks of Human Nature

    CERN Document Server

    Frey, Ulrich J; Willführ, Kai P

    2011-01-01

    To understand why we humans are as we are, it is necessary to look at the essential building blocks that comprise our nature. The foundations of this structure are our evolutionary origins as primates and our social roots. Upon these rest features such as our emotions, language and aesthetic preferences, with our self-perceptions, self-deceptions and thirst for knowledge right at the top. The unifying force holding these blocks together is evolutionary theory. Evolution provides a deeper understanding of human nature and, in particular, of the common roots of these different perspectives. To build a reliable and coherent model of man, leading authors from fields as diverse as primatology, anthropology, neurobiology and philosophy have joined forces to present essays  each describing their own expert perspective. Together they provide a convincing and complete picture of our own human nature.

  15. Osmosis and thermodynamics explained by solute blocking

    Science.gov (United States)

    Nelson, Peter Hugo

    2016-01-01

    A solute-blocking model is presented that provides a kinetic explanation of osmosis and ideal solution thermodynamics. It validates a diffusive model of osmosis that is distinct from the traditional convective flow model of osmosis. Osmotic equilibrium occurs when the fraction of water molecules in solution matches the fraction of pure water molecules that have enough energy to overcome the pressure difference. Solute-blocking also provides a kinetic explanation for why Raoult’s law and the other colligative properties depend on the mole fraction (but not the size) of the solute particles, resulting in a novel kinetic explanation for the entropy of mixing and chemical potential of ideal solutions. Some of its novel predictions have been confirmed, others can be tested experimentally or by simulation. PMID:27225298

  16. ISS EPS Orbital Replacement Unit Block Diagrams

    Science.gov (United States)

    Schmitz, Gregory V.

    2001-01-01

    The attached documents are being provided to Switching Power Magazine for information purposes. This magazine is writing a feature article on the International Space Station Electrical Power System, focusing on the switching power processors. These units include the DC-DC Converter Unit (DDCU), the Bi-directional Charge/Discharge Unit (BCDU), and the Sequential Shunt Unit (SSU). These diagrams are high-level schematics/block diagrams depicting the overall functionality of each unit.

  17. Klebsiella oxytoca Endocarditis With Complete Heart Block

    Directory of Open Access Journals (Sweden)

    Saad Ullah MD

    2016-08-01

    Full Text Available Gram-negative bacterial endocarditis causes 5% of all bacterial endocarditis. Among gram-negative bacteria, Klebsiella species are rare causes of native valve endocarditis. Klebsiella oxytoca is an extremely rare subspecies that can infrequently cause endocarditis and is associated with poor outcome. We report a case of Klebsiella oxytoca endocarditis in an elderly man who initially presented with stroke but later developed sepsis and heart block secondary to endocarditis.

  18. SODART optical block of the SRG satellite

    DEFF Research Database (Denmark)

    Christensen, Finn Erland; Frederiksen, P.; Polny, Josef

    1998-01-01

    This paper describes the design and the successful integration of the optical block of the SODART telescopes to be flown on the Spectrum Roentgen Gamma satellite. The integration involves both the integration of the two high throughput x-ray telescopes as well as the objective crystal spectrometer....... The integrated unit meets all mechanical, thermal and optical specifications and it is now in safe storage in Moscow and awaits further integration procedures with the remaining satellite structure....

  19. Hyperkalemia-induced complete heart block

    Directory of Open Access Journals (Sweden)

    Alireza Baratloo

    2015-05-01

    Full Text Available Background: Potassium, as an extracellular ion, plays an important role in the electrophysiologic function of the myocardium and any change in extracellular concentration of this ion might have a marked impression upon myocyte electrophysiologic gain. High serum potassium levels are thought to impair pulse conduction in Purkinje fibers and ventricles more than that in the Atrioventricular (AV node. Therefore, although complete AV block can occur, it is a rare initial presentation. Case Report: We describe a 62-year-old man with a history of diabetes mellitus, ischemic heart disease and previous Coronary Artery Bypass Graft (CABG, who came to our emergency department due to generalized weakness starting 2 days before admission. The patient also had decreased force in lower limbs, exacerbating from the morning, and was finally diagnosed as a hyperkalemia-induced Complete Heart Block (CHB. It should also be noted that the patient responded dramatically to the administration of 10 mL of 10% calcium gluconate along with external pacing until potassium level correction became effective. Conclusion: In spite of the fact that Hyperkalemia can be associated with frequent Electrocardiogram (ECG abnormality, advanced heart blocks (second- and third-degree AV blocks are usually found only in patients with pre-existing heart failure, conduction abnormalities, or other cardiac diseases. Institution of effective treatment rapidly and forgiveness of traditional non-effective, time consumptive and sometimes risking full-adjustment modalities, such as sodium bicarbonate infusion or exchange resins that prevent their use in the emergent phase, can help minimize patient morbidity and mortality.

  20. Building blocks for protein interaction devices

    OpenAIRE

    Gr?nberg, Raik; Ferrar, Tony S.; van der Sloot, Almer M.; Constante, Marco; Serrano, Luis

    2010-01-01

    Here, we propose a framework for the design of synthetic protein networks from modular protein?protein or protein?peptide interactions and provide a starter toolkit of protein building blocks. Our proof of concept experiments outline a general work flow for part?based protein systems engineering. We streamlined the iterative BioBrick cloning protocol and assembled 25 synthetic multidomain proteins each from seven standardized DNA fragments. A systematic screen revealed two main factors contro...

  1. Concentration of Magnetization for Linear Block Codes

    OpenAIRE

    Korada, Satish Babu; Kudekar, Shrinivas; Macris, Nicolas

    2008-01-01

    We consider communication over the binary erasure and the binary additive white gaussian noise channels using fixed linear block codes and also appropriate ensembles of such codes. We show concentration of the magnetization over the channel realizations and also over the code ensembles. The result has various implications. For the binary erasure channel, the result implies the concentration of the fraction of bits in error over the randomness in both noise and code realization, and that of th...

  2. The Role of Continuous Peripheral Nerve Blocks

    OpenAIRE

    José Aguirre; Alicia Del Moral; Irina Cobo; Alain Borgeat; Stephan Blumenthal

    2012-01-01

    A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of po...

  3. Observations on the SIMON Block Cipher Family

    DEFF Research Database (Denmark)

    Kölbl, Stefan; Leander, Gregor; Tiessen, Tyge

    2015-01-01

    In this paper we analyse the general class of functions underlying the Simon block cipher. In particular, we derive efficiently computable and easily implementable expressions for the exact differential and linear behaviour of Simon-like round functions. Following up on this, we use those express...... variants. Finally, we investigate a large set of Simon variants using different rotation constants with respect to their resistance against differential and linear cryptanalysis. Interestingly, the default parameters seem to be not always optimal....

  4. Blocking transmission of vector-borne diseases.

    Science.gov (United States)

    Schorderet-Weber, Sandra; Noack, Sandra; Selzer, Paul M; Kaminsky, Ronald

    2017-04-01

    Vector-borne diseases are responsible for significant health problems in humans, as well as in companion and farm animals. Killing the vectors with ectoparasitic drugs before they have the opportunity to pass on their pathogens could be the ideal way to prevent vector borne diseases. Blocking of transmission might work when transmission is delayed during blood meal, as often happens in ticks. The recently described systemic isoxazolines have been shown to successfully prevent disease transmission under conditions of delayed pathogen transfer. However, if the pathogen is transmitted immediately at bite as it is the case with most insects, blocking transmission becomes only possible if ectoparasiticides prevent the vector from landing on or, at least, from biting the host. Chemical entities exhibiting repellent activity in addition to fast killing, like pyrethroids, could prevent pathogen transmission even in cases of immediate transfer. Successful blocking depends on effective action in the context of the extremely diverse life-cycles of vectors and vector-borne pathogens of medical and veterinary importance which are summarized in this review. This complexity leads to important parameters to consider for ectoparasiticide research and when considering the ideal drug profile for preventing disease transmission. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Conformal blocks and generalized Selberg integrals

    Energy Technology Data Exchange (ETDEWEB)

    Mironov, A., E-mail: mironov@lpi.r [Lebedev Physics Institute (Russian Federation); ITEP, Moscow (Russian Federation); Morozov, Al., E-mail: morozov@itep.r [ITEP, Moscow (Russian Federation); Morozov, And., E-mail: andrey.morozov@itep.r [ITEP, Moscow (Russian Federation); Physics Department, Moscow State University, Moscow (Russian Federation)

    2011-02-11

    Operator product expansion (OPE) of two operators in two-dimensional conformal field theory includes a sum over Virasoro descendants of other operator with universal coefficients, dictated exclusively by properties of the Virasoro algebra and independent of choice of the particular conformal model. In the free field model, these coefficients arise only with a special 'conservation' relation imposed on the three dimensions of the operators involved in OPE. We demonstrate that the coefficients for the three unconstrained dimensions arise in the free field formalism when additional Dotsenko-Fateev integrals are inserted between the positions of the two original operators in the product. If such coefficients are combined to form an n-point conformal block on Riemann sphere, one reproduces the earlier conjectured {beta}-ensemble representation of conformal blocks. The statement can also be regarded as a relation between the 3j-symbols of the Virasoro algebra and the slightly generalized Selberg integrals I{sub Y}, associated with arbitrary Young diagrams. The conformal blocks are multilinear combinations of such integrals and the AGT conjecture relates them to the Nekrasov functions which have exactly the same structure.

  6. David MacKay's wooden blocks

    Science.gov (United States)

    Skilling, John

    2017-06-01

    This paper is dedicated to the memory of Professor Sir David MacKay FRS. In his inspiring last talk, MacKay discussed the problem of packing his young son's identical wooden blocks, of size 2×1×1. How many ways are there of packing n3/2 such blocks into a cubical box of volume n3? This is the same problem as finding the entropy of cubic packing of dimeric molecules, so the investigation is not merely childish. Here, I use this example as an exemplar of the use of nested sampling in computational inference. In this analogy, the posterior covers the "glassy" arrangements of non-overlapping blocks in the box, whereas the prior represents the wider set of unrestricted model configurations. The required number of possible glass states is the compressive prior-to-posterior fraction of the known number of model configurations. And the compression (as logarithm) is immediately available from the number of equilibrating iterations in nested sampling. The clarity of this example offers useful lessons for computational inference more generally.

  7. Channel blocking of MspA revisited.

    Science.gov (United States)

    Perera, Ayomi S; Wang, Hongwang; Basel, Matthew T; Pokhrel, Megh Raj; Gamage, Pubudu Siyambalagoda; Kalita, Mausam; Wendel, Sebastian; Sears, Bryan; Welideniya, Dhanushi; Liu, Yao; Turro, Claudia; Troyer, Deryl L; Bossmann, Stefan H

    2013-01-08

    Porin A from Mycobacterium smegmatis (MspA) is a highly stable, octameric channel protein, which acts as the main transporter of electrolytes across the cell membrane. MspA features a narrow, negatively charged constriction zone, allowing stable binding of various analytes thereby blocking the channel. Investigation of channel blocking of mycobacterial porins is of significance in developing alternate treatment methods for tuberculosis. The concept that ruthenium(II)quaterpyridinium complexes have the capability to act as efficient channel blockers for MspA and related porins, emerged after very high binding constants were measured by high-performance liquid chromatography and steady-state luminescence studies. Consequently, the interactions between the ruthenium(II) complex RuC2 molecules and MspA, leading to RuC2@MspA assemblies, have been studied utilizing time-resolved absorption/emission, atomic force microscopy, dynamic light scattering, ζ potential measurements, and isothermal titration calorimetry. The results obtained provide evidence for the formation of clusters/large aggregates of RuC2 and MspA. The results are of interest with respect to utilizing prospective channel blockers in porins. The combination of results from conceptually different techniques shed some light onto the chemical nature of MspA-channel blocker interactions thus contributing to the development of a paradigm for channel blocking.

  8. Block Storage Service: Status and Performance

    CERN Document Server

    Van der Ster, Daniel

    2014-01-01

    This memo summarizes the current status of the Ceph block storage service as it is used for OpenStack Cinder Volumes and Glance Images as of May 2014. We present the block storage activity on the current cluster, measuring IOPS and latencies, and present a cost/benefit analysis of using SSDs to optimize the cost and performance efficiency of the service. During tests in collaboration with IT-CF, we have concluded that by adding SSDs as the synchronous write journals (used to guarantee data durability), we are able increase the IOPS capacity by 4-5 times, at a cost of decreasing the available volume by 20%. Further, the testing has shown that the Ceph implementation is able to operate at the limit of the hardware performance; software-induced performance limitations were not yet observed in either the spinning disk or SSD configurations. In addition, we believe that increasing small write performance with SSDs is applicable only to the block storage use-case; high-bandwidth use-cases such as physics data stora...

  9. Variant Purification of an Allogeneic Bone Block

    Science.gov (United States)

    Lorenz, Jonas; Schlee, Markus; Al-Maawi, Sarah; Chia, Poju; Sader, Robert A.

    2017-01-01

    Objective This short communication reports on a histological analysis of the composition of the commercially available Maxgraft® allogeneic bone block. Materials and Methods Based on previously published, easily applicable histological methods, blanc samples of the Maxgraft® allogeneic bone block have been decalcified, dehydrated and embedded in paraffin before histological and histochemical staining. Afterwards, the slides were evaluated for their material characteristics, such as the bone matrix structure and other components, including collagen or cells/cell remnants. Results The results show that this bone block exhibits a trabecular structure with lamellar sub-organization. Additionally, cellular remnants within the osteocyte lacunae and at the outer trabecular surfaces reside together with remnants of the former inter-trabecular fatty and connective tissue, i.e., collagenous structures and connective tissue cells or cell remnants. Conclusion Consistent with a previous study on this topic, the data presented here demonstrate that some of the certified purification techniques might not allow for the production of allogeneic materials free of organic cell and tissue components. PMID:28827851

  10. Conformal blocks and generalized Selberg integrals

    Science.gov (United States)

    Mironov, A.; Morozov, Al.; Morozov, And.

    2011-02-01

    Operator product expansion (OPE) of two operators in two-dimensional conformal field theory includes a sum over Virasoro descendants of other operator with universal coefficients, dictated exclusively by properties of the Virasoro algebra and independent of choice of the particular conformal model. In the free field model, these coefficients arise only with a special “conservation” relation imposed on the three dimensions of the operators involved in OPE. We demonstrate that the coefficients for the three unconstrained dimensions arise in the free field formalism when additional Dotsenko-Fateev integrals are inserted between the positions of the two original operators in the product. If such coefficients are combined to form an n-point conformal block on Riemann sphere, one reproduces the earlier conjectured β-ensemble representation of conformal blocks. The statement can also be regarded as a relation between the 3j-symbols of the Virasoro algebra and the slightly generalized Selberg integrals I, associated with arbitrary Young diagrams. The conformal blocks are multilinear combinations of such integrals and the AGT conjecture relates them to the Nekrasov functions which have exactly the same structure.

  11. SAR Tomography Based on Block Compressive Sensing

    Directory of Open Access Journals (Sweden)

    Wang Aichun

    2016-02-01

    Full Text Available While the use of SAR Tomography (TomoSAR based on Compressive Sensing (CS makes it possible to reconstruct the height profile of an observed scene, the performance of the reconstruction decreases for a structural observed scene. To deal with this issue, we propose using TomoSAR based on Block Compressive Sensing (BCS, which changes the reconstruction of the structural observed scene into a BCS problem under the principles of CS. Further, the block size is established by utilizing the relationship between the characteristics of the structural observed scene and the SAR parameters, such that the BCS problem is efficiently solved with a block sparse l1/l2 norm optimization signal model. Compared with existing CSTomoSAR methods, the proposed BCS-TomoSAR method makes better use of the sparsity and structure information of a structural observed scene, and has higher precision and better reconstruction performance. We used simulations and Radarsat-2 data to verify the effectiveness of this proposed method.

  12. Brucella Infection Associated with Complete Atrioventricular Block.

    Science.gov (United States)

    Bilici, Meki; Demir, Fikri; Yılmazer, Murat Muhtar; Bozkurt, Fatma; Tuzcu, Volkan

    2016-09-01

    The clinical spectrum of Brucella infection is quite diverse and characterized by multi-system involvement. Patients present with myocarditis, endocarditis, or pericarditis. Infective endocarditis is the most common cardiovascular complication in patients with brucellosis. Although conduction abnormalities are seen in cases with endocarditis, they are reported very rarely in the setting of cardiac Brucella infection. An eight and a half-year-old male patient was referred to our clinic due to inadequate response to cotrimaxazole plus streptomycin treatment at the 15th day of admission. Although local hospital records on the patient showed a heart rate of 80 bpm, we determined a heart rate of 46 bpm. The electrocardiogram showed complete atrioventricular (AV) block. The average heart rate was determined as 48 bpm with 24-hour Holter electrocardiogram (ECG) monitoring. The echocardiographic examination showed normal-sized heart chambers and the absence of valvular involvement. An agglutination test for brucellosis was found to be positive with a titer of 1/320. High fever, arthralgia, and splenomegaly regressed following doxycycline plus rifampicin therapy, but there was no improvement in the AV block. A permanent pacemaker was implanted because of the detection of an average heart rate of 48 bpm. Because cardiac failure and rhythm abnormalities are reported in the course of Brucella infection and may be associated with significant outcomes, cases with brucellosis should be evaluated carefully in terms of cardiac involvement. This report aims to draw attention to complete AV block as an extremely rare complication of Brucella infection.

  13. Decoupled Block-Wise ILU(k) Preconditioner on GPU

    OpenAIRE

    Yang, Bo; Liu, Hui; Zhong, He; Chen, Zhangxin

    2017-01-01

    This research investigates the implementation mechanism of block-wise ILU(k) preconditioner on GPU. The block-wise ILU(k) algorithm requires both the level k and the block size to be designed as variables. A decoupled ILU(k) algorithm consists of a symbolic phase and a factorization phase. In the symbolic phase, a ILU(k) nonzero pattern is established from the point-wise structure extracted from a block-wise matrix. In the factorization phase, the block-wise matrix with a variable block size ...

  14. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers.

    Science.gov (United States)

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W

    2015-01-01

    The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.

  15. An Unusual Cause of Transient Ischemic Attack in a Patient with Pacemaker

    Directory of Open Access Journals (Sweden)

    Jagadeesh Kumar Kalavakunta

    2014-01-01

    Full Text Available Pacemaker lead malposition in various locations has been described in the literature. Lead malposition in left ventricle is a rare and an underdiagnosed complication. We present a 77-year-old man with history of atrial fibrillation and pacemaker placement who was admitted for transient ischemic attack. He was on aspirin, beta blocker, and warfarin with subtherapeutic international normalized ratio. His paced electrocardiogram showed right bundle-branch block, rather than the typical pattern of left bundle-branch block, suggesting pacemaker lead malposition. Further, his chest X-ray and echocardiogram confirmed the pacemaker lead position in the left ventricle instead of right ventricle. He refused surgical removal of the lead and we increased his warfarin dose. Diagnosis of lead malposition in left ventricle, though easy to identify in echocardiogram, requires high index of clinical suspicion. In asymptomatic patients, surgical removal may be deferred for treatment with lifelong anticoagulation.

  16. An unusual pacemaker malposition and delayed diagnosis

    Directory of Open Access Journals (Sweden)

    Bircan Alan

    2015-06-01

    Full Text Available Transvenous right ventricular pacing usually shows a left bundle branch block (LBBB pattern. When right bundle branch block (RBBB pattern appears after the insertion of an electrode, perforation or malposition of the pacing lead usually occurs. However, when the pacing lead that is inserted into the coronary sinus or right ventricle extends to right ventricle septum, RBBB pattern may appear. Echocardiography, due to inadequate echo images or reflections, may result in early clinical misdiagnosis since it cannot be evaluated well. Another reason for the errors in diagnosis is that cardiologists generally relegate telegraphy evaluations to a second plan. Here, we present a case of pacemaker malposition, which was diagnosed using X-ray radiography after multiple failed evaluations with echocardiography.

  17. Arrhythmia Identification with Two-Lead Electrocardiograms Using Artificial Neural Networks and Support Vector Machines for a Portable ECG Monitor System

    Directory of Open Access Journals (Sweden)

    Shing-Hong Liu

    2013-01-01

    Full Text Available An automatic configuration that can detect the position of R-waves, classify the normal sinus rhythm (NSR and other four arrhythmic types from the continuous ECG signals obtained from the MIT-BIH arrhythmia database is proposed. In this configuration, a support vector machine (SVM was used to detect and mark the ECG heartbeats with raw signals and differential signals of a lead ECG. An algorithm based on the extracted markers segments waveforms of Lead II and V1 of the ECG as the pattern classification features. A self-constructing neural fuzzy inference network (SoNFIN was used to classify NSR and four arrhythmia types, including premature ventricular contraction (PVC, premature atrium contraction (PAC, left bundle branch block (LBBB, and right bundle branch block (RBBB. In a real scenario, the classification results show the accuracy achieved is 96.4%. This performance is suitable for a portable ECG monitor system for home care purposes.

  18. Lifting of a sector block for YE-2 at Kawasaki.

    CERN Document Server

    R. Loveless/U. of Wisconsin

    2000-01-01

    YE-2 is build from machined sector blocks. Trial assembly is carried out horizontally. This picture represents the lifting of a machined sector block destined to the trial assembly of a half disk YE-2 at Kawasaki (KHI) Kobe, Japan.

  19. Alaska NAD 83 Composite Block Diagram (CBD) Images

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This data set contains Composite Block Diagram (CBD) images in Adobe pdf format for areas within the BOEM Alaska Region. Each CBD describes a single block within an...

  20. Radial Nerve Injury after Brachial Nerve Block - Case Series

    Directory of Open Access Journals (Sweden)

    Szederjesi Janos

    2016-03-01

    Full Text Available Adding epinephrine to local anesthetics is recommended to extend the duration of peripheral nerve blocks. We describe in this article two cases of radial nerve injury possible due to coadministration of epinephrine during brachial plexus block.