Reservations about the Selvester QRS score in left bundle branch block - Experience in patients with transcatheter aortic valve implantation

Abstract

Background: The Selvester QRS score (S-score) estimates myocardial scar using electrocardiographic criteria. We evaluated the S-score for left bundle branch block (LBBB).

Material and methods: Studied were 36 patients who developed persistent LBBB upon transcatheter aortic valve implantation (TAVI, TAVI-LBBB group) and 36 matched patients with persistent narrow QRS (TAVI-nQRS group). Electrocardiograms were recorded before and briefly after TAVI and during ~6months follow-up. S-score was calculated using criteria for hypertrophic (in absence of LBBB) or LBBB hearts.

Results: In TAVI-LBBB patients correlation between S-scores pre-TAVI and post-TAVI was absent (R²=0.023). High S-scores post-TAVI occurred in patients with low pre-TAVI scores. Pre-post TAVI scores correlated weakly in TAVI-nQRS (R²=0.182), indicating a possible influence of ventricular unloading by TAVI. In both groups S-scores at post-TAVI and follow-up compared reasonably (R²=0.389 and R²=0.386), indicating reproducibility in more stable conditions.

Conclusion: This study indicates that the use of the LBBB S-score criteria overestimates scar size and that caution is recommended in the use of the score in patients with LBBB.

Keywords: Electrocardiography; Left bundle branch block; Myocardial scar; Selvester QRS scoring; Transcatheter aortic valve implantation.