The Diagnostic Value Of Crochetage Wave In Inferior Leads Of ECG And Right Bundle Branch Block In Patent Foramen Ovale

Background and Purpose:Crochetage wave in inferior leads(leads ?,?,av F)and right bundle branch block(RBBB)are ECG indicators of atrial septal defect(ASD),Because patent foramen ovale(PFO)and ASD occur in similar locations,the above ECG changes of ASD may also be used as a marker of PFO.The purpose of this study was to investigate the diagnostic value and clinical significance of Crochetage wave in inferior leads of ECG and RBBB in PFO.Methods:One hundred and thirteen consecutive patients who were diagnosed with PFO and right-to-left shunt by contrast-enhanced echocradiography and were treated with PFO occlusion in the Department of Cardiology of China-Japan Union Hospital of Jilin University from Janauary to December 2017 were selected as the PFO group,One hundred and thirteen healthy people who were diagnosed without PFO by contrast-enhanced echocardiography during the same period were used as the control group.At the same time,according to the corresponding diagnostic criteria,a subgroup analysis was performed on the 113 patients with PFO.PFO was divided into a large amount of shunt group,a medium amount of shunt group,and a small amount of shunt group based on the degree of right-to-left shunt;According to the presence or absence of stroke,it was divided into PFO with stroke group and PFO without stroke group;According to the presence or absence of atrial septal aneurysm(ASA),it was divided into PFO with ASA group and PFO without ASA group;According to the success of PFO occlusion surgery,it was divided into PFO occlusion success group and PFO occlusion failure group.All the patients were examined and measured with an electrocardiogrm recorder used clinically in our hospital.The measured indicators include:(1)The number of Crochetage wave in a single lead.(2)The number of Crochetage wave in two leads.(3)The number of Crochetage wave in three leads.(4)The number of Crochetage wave in ?1 lead.(5)The number of Crochetage wave in?2 leads.(6)The number of Crochetage wave in ?1 lead plus RBBB.(7)The number of Crochetage wave in ?2 leads plus RBBB.(8)The number of Crochetage wave in 3leads plus RBBB.The differences of the above ECG indicators between the PFO group and the control group,as well as between the subgroups within the PFO group were compared.Results:Among the 113 patients with PFO enrolled,the incidence of Crochetage wave in the inferior leads and RBBB of the ECG was 29.20% and 15.04%,respectively;wheras the incidence of the control group was 7.96% and 3.54%,respectively.Take the single lead,double leads,? 1 lead,? 2 leads Crochetage wave,RBBB,? 1lead Crochetage wave combined with RBBB,? 2 leads Crochetage wave combined with RBBB as diagnostic methods,the difference in the incidence of the above different indicators between the PFO and control groups was statistically significant(P <0.05).The sensitivity,specificity,positive predictive value,and negative predictive value of Crochetage wave in ? 1 inferior lead for the diagnosis of PFO were 29.20%,92.04%,78.57%,and 56.52%,respectively.The single-lead Crochetage wave,double-lead Crochetage wave,three-lead Crochetage wave,? 1 lead Crochetage wave,? 2 leads Crochetage wave have a specificity of >92.04% for the diagnosis of PFO.The specificity of the Crochetage wave in the three inferior leads reached 100%.The specificity of ? 1 lead Crochetage wave combined with RBBB,? 2 leads Crochetage wave combined with RBBB,3 leads Crochetage wave combined with RBBB for the diagnosis of PFO was 99.12%,100%,and 100%.The highest diagnostic value was ? 1 lead Crochetage wave,and its diagnostic index was121.24%.In subgroup analysis,there was no significant difference in the incidence of Crochetage wave in inferior leads and RBBB among the PFO patients with different shunt degrees(P >0.05).The incidence of the Crochetage wave in inferior leads and RBBB of the PFO associated with stroke group were 50.00% and 26.67%,respectively,which were higher than the 18.75% and 7.81%,respectively in the PFO group without stroke.There was a significant difference in the incidence of single lead Crochetage wave,? 1 lead Crochetage wave,? 1 lead Crochetage wave combined with RBBB between the two groups(P <0.05).The incidence of Crochetage wave in the inferior leads and RBBB of PFO associated with ASA subgroup was 80.00% and 30.00%,respectively,which was higher than 24.27% and13.59%,respectively in the PFO subgroup without ASA.There was a significant difference in the incidence of double lead,three lead Crochetage wave,? 1 lead Crochetage wave,? 2 leads Crochetage wave between the two groups(P <0.05).In addition,no significant difference was noted in the incidence of Crochetage wave of the inferior leads and RBBB between the successful and unsuccessful PFO closure subgroups.Conclusions:This study found that the Crochetage wave appeared in the inferior leads of ECG,especially the simultaneous presence of RBBB had certain clinical significance for the diagnosis of PFO.It is also helpful for the early identification of patients with PFO associated with stroke and/or ASA.The presence of Crochetage wave in inferior leads and / or RBBB of traditional 12-lead ECG may be a new feasible indicator for the diagnosis of PFO.