Hostname: page-component-77f85d65b8-pztms Total loading time: 0 Render date: 2026-04-19T22:46:22.952Z Has data issue: false hasContentIssue false
  • English
  • Français

Right bundle branch block as a marker for interatrial septal abnormalities

Published online by Cambridge University Press:  23 June 2011

Aurora Bakalli ,
Dardan Koçinaj ,
Ljubica Georgievska-Ismail ,
Tefik Bekteshi ,
Ejup Pllana  and
Basri Sejdiu
Aurora Bakalli*
Affiliation:
Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosovo
Dardan Koçinaj
Affiliation:
Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosovo
Ljubica Georgievska-Ismail
Affiliation:
Outpatient Department for Coronary Artery Disease, University Clinic of Cardiology, Medical School, University ‘St. Cyril and Methodius’, Skopje, Macedonia
Tefik Bekteshi
Affiliation:
Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosovo
Ejup Pllana
Affiliation:
Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosovo
Basri Sejdiu
Affiliation:
Department of Cardiology, Clinic of Internal Medicine, University Clinical Center of Kosova, Prishtina, Kosovo
*
Correspondence to: A. Bakalli, Rr. Gazmend Zajmi nr. 23, 10000 Prishtina, Kosovo. Tel: +37744151111; Fax: +38138223153; E-mail: abakalli@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

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.

Methods and results

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).

Conclusions

Right bundle branch block should serve as a valuable indicator to motivate a detailed search for interatrial septal abnormalities.

Keywords

Atrial septal defectpatent foramen ovaleatrial septal aneurysmtransesophageal echocardiography

Information

Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 18 - 25
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1. Rosas, M, Attie, F. Atrial septal defects in adults. Timely Top Med Cardiovasc Dis 2007; 11: E34.Google ScholarPubMed
2. Meissner, I, Khandheria, BK, Heit, JA, et al. Patent foramen ovale: innocent or guilty? Evidence from a prospective population-based study. J Am Coll Cardiol 2006; 47: 440–445.CrossRefGoogle ScholarPubMed
3. Kizer, JR, Devereux, RB. Clinical practice. Patent foramen ovale in young adults with unexplained stroke. N Engl J Med 2005; 353: 2361–2372.CrossRefGoogle ScholarPubMed
4. Hara, H, Virmani, R, Ladich, E, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol 2005; 46: 1768–1776.CrossRefGoogle ScholarPubMed
5. Mügge, A, Daniel, WG, Angermann, C, et al. Atrial septal aneurysm in adult patients. A multicenter study using transthoracic and transesophageal echocardiography. Circulation 1995; 91: 2785–2792.CrossRefGoogle ScholarPubMed
6. Olivares-Reyes, A, Chan, S, Lazar, EJ, Bandlamudi, K, Narla, V, Ong, K. Atrial septal aneurysm: a new classification in two hundred five adults. J Am Soc Echocardiogr 1997; 10: 644–656.CrossRefGoogle ScholarPubMed
7. Homma, S, Sacco, RL. Patent foramen ovale and stroke. Circulation 2005; 112: 1063–1072.CrossRefGoogle ScholarPubMed
8. Wu, LA, Malouf, JF, Dearani, JA, et al. Patent foramen ovale in cryptogenic stroke: current understanding and management options. Arch Intern Med 2004; 164: 950–956.CrossRefGoogle ScholarPubMed
9. Overell, JR, Bone, I, Lees, KR. Interatrial septal abnormalities and stroke: a meta-analysis of case-control studies. Neurology 2000; 55: 1172–1179.CrossRefGoogle ScholarPubMed
10. Pearson, AC, Nagelhout, D, Castello, R, Gomez, CR, Labovitz, AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol 1991; 18: 1223–1229.CrossRefGoogle ScholarPubMed
11. Lang, RM, Biering, M, Devereux, RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 1440–1463.CrossRefGoogle Scholar
12. Sung, RJ, Tamer, DM, Agha, AS, Castellanos, A, Myerburg, RJ, Gelband, H. Etiology of the electrocardiographic pattern of “incomplete right bundle branch block” in atrial septal defect: an electrophysiologic study. J Pediatr 1975; 87: 1182–1186.CrossRefGoogle ScholarPubMed
13. Moore, EN, Hoffman, BF, Patterson, DF, Stuckey, JH. Electrocardiographic changes due to delayed activation of the wall of the right ventricle. Am Heart J 1964; 68: 347–361.CrossRefGoogle ScholarPubMed
14. Carmichael, DB, Forrester, RH, Inmon, TW, Mattingly, TW, Pollock, BE, Walker, WJ. Electrocardiographic and hemodynamic correlation in atrial septal defect. Am Heart J 1956; 52: 547–561.Google ScholarPubMed
15. Milnor, WR, Bertrand, CA. The electrocardiogram in atrial septal defect: a study of twenty-four cases, with observations on the RSR’-V1 pattern. Am J Med 1957; 22: 223–233.CrossRefGoogle ScholarPubMed
16. Burch, GE, DePasquale, N. The electrocardiogram and ventricular gradient in atrial septal defect. Am Heart J 1959; 58: 190–203.CrossRefGoogle ScholarPubMed
17. Boineau, JP, Spach, MS, Ayers, CR. Genesis of the electrocardiogram in atrial septal defect. Am Heart J 1964; 68: 637–651.CrossRefGoogle ScholarPubMed
18. Belvís, R, Leta, RG, Martínez-Domeño, A, et al. Electrocardiographic findings in patients with cryptogenic ischemic stroke and patent foramen ovale. J Electrocardiol 2007; 40: 168–171.CrossRefGoogle ScholarPubMed
19. Heller, J, Hagege, AA, Besse, B, Desnos, M, Marie, FN, Guerot, C. “Crochetage” (notch) on R wave in inferior limb leads: a new independent electrocardiographic sign of atrial septal defect. J Am Coll Cardiol 1996; 27: 877–882.CrossRefGoogle Scholar
20. Ay, H, Buonanno, FS, Abraham, SA, Kistler, JP, Koroshetz, WJ. An electrocardiographic criterion for diagnosis of patent foramen ovale associated with ischemic stroke. Stroke 1998; 29: 1393–1397.CrossRefGoogle ScholarPubMed
21. Chan, KY, Yip, WC, Tay, JS, Rajan, U. Detection of cardiac problems among school children by health screening. J Trop Pediatr 1989; 35: 221–224.CrossRefGoogle ScholarPubMed
22. Bakalli, A, Kamberi, L, Pllana, E, Gashi, A. 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. Cases J 2008; 1: 51.CrossRefGoogle ScholarPubMed
23. Lechat, P, Mas, JL, Lascault, G, et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988; 318: 1148–1152.CrossRefGoogle ScholarPubMed
24. Mas, JL, Arquizan, C, Lamy, C, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001; 345: 1740–1746.CrossRefGoogle ScholarPubMed
25. Torti, SR, Billinger, M, Schwerzmann, M, et al. Risk of decompression illness among 230 scuba divers in relation to the presence and size of patent foramen ovale. Eur Heart J 2004; 25: 1014–1020.CrossRefGoogle Scholar
26. Anzola, GP, Magoni, M, Guindani, M, Rozzini, L, Dalla Volta, G. Potential source of cerebral embolism in migraine with aura: a transcranial Doppler study. Neurology 1999; 52: 1622–1625.CrossRefGoogle ScholarPubMed
27. Cheng, TO. Platypnea-orthodeoxia: what causes water to flow uphill? Circulation 2002; 105: e47.CrossRefGoogle ScholarPubMed
28. Belkin, RN, Hurwitz, BJ, Kisslo, J. Atrial septal aneurysm: association with cerebrovascular and peripheral embolic events. Stroke 1987; 18: 856–862.CrossRefGoogle ScholarPubMed
29. Marazanof, M, Roudaut, R, Cohen, A, et al. Atrial septal aneurysm. Morphologic characteristics in a large population: pathological associations. A French multicenter study on 259 patients investigated by transesophageal echocardiography. Int J Cardiol 1995; 52: 59–65.CrossRefGoogle Scholar
30. Nighoghossian, N, Perinetti, M, Barthelet, M, Adeleine, P, Trouillas, P. Potential cardioembolic source of stroke in patients less than 60 years of age. Eur Heart J 1996; 17: 590–594.CrossRefGoogle ScholarPubMed
31. Agmon, Y, Khandheria, BK, Meissner, I, et al. Frequency of atrial septal aneurysm in patients with cerebral ischemic events. Circulation 1999; 99: 1942–1944.CrossRefGoogle ScholarPubMed
32. Meissner, I, Whisnant, JP, Khandheria, BK, et al. Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study (Stroke Prevention: Assessment of Risk in a Community). Mayo Clin Proc 1999; 74: 862–869.CrossRefGoogle ScholarPubMed
33. Zabalgoitia-Reyes, M, Herrera, C, Gandhi, DK, Mehlman, DJ, McPherson, DD, Talano, JV. A possible mechanism for neurologic ischemic events in patients with atrial septal aneurysm. Am J Cardiol 1990; 66: 761–764.CrossRefGoogle ScholarPubMed
34. Schneider, B, Harath, P, Vogel, P, Meinertz, T. Improved morphologic characterization of atrial septal aneurysm by transesophageal echocardiography: relation to cerebrovascular events. J Am Coll Cardiol 1990; 16: 1000–1009.CrossRefGoogle ScholarPubMed
35. Cabanes, L, Mas, JL, Cohen, A, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age. Stroke 1993; 24: 1865–1873.CrossRefGoogle ScholarPubMed
36. Lechat, P, Lascault, G, Mas, JL, et al. Prevalence of patent foramen ovale in young patients with ischemic cerebral complications. Arch Mal Coeur Vaiss 1989; 82: 847–852.Google ScholarPubMed
37. Hanrath, P, Schluter, M, Langenstein, B, et al. Detection of ostium secundum atrial septal defects by transoesophageal cross-sectional echocardiography. Br Heart J 1983; 49: 350–358.CrossRefGoogle ScholarPubMed
38. Hanley, PC, Tajik, AJ, Hynes, JK, et al. Diagnosis and classification of atrial septal aneurysm by two-dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol 1985; 6: 1370–1382.CrossRefGoogle ScholarPubMed
39. Comess, KA, DeRook, FA, Beach, KW, Lytle, NJ, Golby, AJ, Albers, GW. Transesophageal echocardiography and carotid ultrasound in patients with cerebral ischaemia: prevalence of findings and recurrent stroke risk. J Am Coll Cardiol 1994; 23: 1598–1603.CrossRefGoogle ScholarPubMed
40. Siostrzonek, P, Zangeneh, M, Gossinger, , et al. Comparison of transesophageal and transthoracic contrast echocardiography for detection of a patent foramen ovale. Am J Cardiol 1991; 68: 1247–1249.CrossRefGoogle ScholarPubMed
41. Di Tullio, M, Sacco, RL, Venketasubramanian, N, Sherman, D, Mohr, JP, Homma, S. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke 1993; 24: 1020–1024.CrossRefGoogle ScholarPubMed