PubMed · 8013525
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J Tomcsányi, K Karlócai. 1994. Complete right bundle branch block.. https://doi.org/10.1093/oxfordjournals.eurheartj.a060520
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We compared 12-lead electrocardiographic changes during exercise in 41 patients with left bundle branch block; 7 were nonischemic and 34 had coronary artery obstruction > or =70% as detected by angiogram. ST depression of > or =0.5 mm from baseline when measured at the J point in leads II and AVF (p=0.004) and an increase of R-wave amplitude in lead II (p=0.05) significantly identified ischemia.
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An abnormal P wave was observed in a child affected by prolonged idiopathic ventricular tachycardia (fascicular tachycardia). After sinus rhythm restoration, the P wave was very tall and peaked (0.5 mV in lead II), suggesting a diagnosis of atrial enlargement. No cardiac abnormality, however, was detected by clinical and echocardiographic examination. The P wave abnormality lasted for about 1 month, with progressive voltage and shape normalization. These P wave changes were probably dependent on tachycardia; since the arrhythmia was long-lasting and characterized by atrioventricular dissociation, repetitive atrial contraction against closed atrioventricular valves caused stretching of atrial fibers, resulting in P wave abnormality. This observation suggests that very prolonged ventricular tachycardia may be associated with an electrocardiographic pattern of pseudoatrial enlargement.