Intraventricular conduction delay

Intraventricular conduction delay Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: QRS prolongation; wide QRS; wide QRS complex; wide QRS complexes; IVCD; IVCDs; intraventricular conduction defect; non-specific intraventricular conduction delay; non-specific intraventricular conduction defect

Overview

Intraventricular conduction delay is characterized by a prolonged time for electrical impulses to traverse the ventricles of the heart as demonstrated by a wide QRS interval or QRS prolongation. The QRS complex represents electrical activation of the ventricle. Widening of the QRS complex may reflect delayed conduction in the bundle of His, bundle branch or purkinje conduction system.

Causes

• Hypothermia
• Incomplete left bundle branch block
• Incomplete right bundle branch block
• Left anterior fascicular block
• Left bundle branch block
• Left posterior fascicular block
• Non-specific intraventricular conduction delay (NSIVCD) (when the QRS is wide and the definitions of LBBB and RBBB are not met)
• Right bundle branch block

EKG Findings

The ECG is in sinus rhythm and the QRS is markedly widened with a QRS duration of 260ms. The QRS seems split and gives the impression of ventricular bigemini but note that the second QRS deflection that looks like a PVC is in fact 200 ms after the onset of the first part of the QRS and hence too early for a PVC. Of interest this patient has recurrent ventricular tachycardia which may relate to his grossly widened QRS.

Sources

Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&dir=prev&offset=20080806182927&limit=500