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Comparative Study
. 2006 Apr;11(2):132-8.
doi: 10.1111/j.1542-474X.2006.00094.x.

Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm

Chatla V R Reddy  1 , Kuruvilla Cheriparambill, Barry Saul, Majesh Makan, John Kassotis, Awaneesh Kumar, Mithilesh Kumar Das
Affiliations
Comparative Study

Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm

Chatla V R Reddy et al. Ann Noninvasive Electrocardiol. 2006 Apr.

Abstract

Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR; pattern or its variant RSr;, rSR;, or rSr;) without evidence of bundle branch block (QRS duration <or=120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR; pattern or its variant) in the left sided leads (I, aVL, V(3) to V(6)) may be a useful sign of LVA.

Methods: ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30 degrees right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs.

Results: The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the positive predictive value of fragmented QRS for LVA after infarction can be estimated at 29-53% and the negative predictive value can be estimated at 95-98%.

Conclusion: The sensitivity of fragmented QRS in left precordial leads for LVA was only 50%, whereas the specificity was 94.5%. It has a relatively low to moderate positive predictive value and high negative predictive value.

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Figures

Figure 1
Figure 1
Different morphologies of RSR` pattern and its variants, and fragmentation of QRS associated with left ventricular aneurysm (more than one sign may be found in one EKG).
Figure 2
Figure 2
rSr` pattern in lead V3, fragmented QRS in lead V4, and RsR` in lead V5 (three signs of LV aneurysm in one EKG).
Figure 3
Figure 3
Fragmented QRS in lead V4 and rSR` pattern in lead V5.
Figure 4
Figure 4
rSr` pattern in lead V3.
Figure 5
Figure 5
RSr` pattern in lead V6.
See this image and copyright information in PMC

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