Diagnosis of myocardial infarction-induced ventricular aneurysm in the presence of complete left bundle branch block

An analysis of the 4,196 files of our Cardiology Clinic cohort showed 128 p atients with a complete left bundle branch block (LBBB) in their electrocar diograms (ECGs). Of these patients, 27 had suffered a myocardial infarction in the past and had been found to have a ventricular aneurysm (VA), docume nted by greater than or equal to1 of several noninvasive and invasive diagn ostic methods. Five of these 27 patients had stable ST-segment elevation in greater than or equal to1 of left precordial ECG leads, with predominantly positive QRS complexes (an ECG criterion for the diagnosis of VA in the pr esence of LBBB, which we have recently described). The sensitivity of this ECG criterion for the diagnosis of VA was 18.5%, and the specificity was 10 0%. The frequency of distribution of VA in the septal, and even more, apica l myocardial regions was higher in the patients with a positive ECG diagnos is of VA, than in the patients with a negative one (P = .049, and P = .009, correspondingly). The number of myocardial territories involved with a VA was not different in the 2 subgroups (P = .325). Pathophysiologically, this ECG alteration diagnostic of VA represents a superimposition of the primar y ST-segment elevation due to the VA, on the expected secondary ST-segment depression due to the LBBB, and represents a summation effect.