Annals of Nuclear Medicine

, Volume 5, Issue 1, pp 19–27 | Cite as

A study of ventricular contraction sequence in complete right bundle branch block by phase analysis

  • Tohoru Takeda
  • Hinako Toyama
  • Kaname Iida
  • Takeshi Masuoka
  • Ryuichi Ajisaka
  • Keisuke Kuga
  • Motohiro Satoh
  • Shinji Sugahara
  • Wu Jin
  • Nobuyoshi Ishikawa
  • Yasuro Sugishita
  • Takao Akatsuka
Original Article


Twenty-four patients with complete right bundle branch block (CRBBB) combined with and without left axis deviation (LAD) on ECG, were compared with 17 normal subjects to evaluate the right ventricular contraction sequence and pattern in detail. Blood pool scintigrams were obtained in the left anterior oblique projection, and these images were analyzed by first component Fourier harmonics.

In the normal subjects, the phase value distribution representing the pattern of ventricular contraction was almost homogeneous in both the right and left ventricles (RV & LV). In the CRBBB patients without LAD, the phase images showed apparent phase delay in the right ventricle. In the CRBBB patients with LAD, the phase images showed many different contraction patterns varying from normal to RV phase delay, owing to the effects of the hemiblock. Quantitative analysis of the absolute values, showed that the mean (RV-LV) value was 6.6±8.4 msec in the normal subjects. In the CRBBB patients without LAD, the duration of the QRS complex correlated with the mean (RV-LV) value, whereas no difference was observed between the duration of the QRS complex and the standard deviation of the right ventricle. Using phase analysis the degree of the RBBB can be determined from the phase images, and can be quantitatively analyzed as in electrical studies.

Key words

phase analysis first harmonic Fourier method right bundle branch block multigated blood pool scintigram ventricular contraction sequence 


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  1. 1.
    Rigo P, Murray M, Strauss HW, et al: Scintiphotographic evaluation of patients with suspected left ventricular aneurysm.Circulation 50: 985–991, 1974PubMedGoogle Scholar
  2. 2.
    Salel AF, Herman DS, DeNardo GL, et al: Radionuclide assessment of nitroglycerin influence on abnormal left ventricular segmental contraction in patients with coronary heart disease.Circulation 53: 975–982, 1976PubMedGoogle Scholar
  3. 3.
    Adam WE, Tarkowska A, Bitter F, et al: Equilibrium (Gated) radionuclide ventriculography.Cardiovascular radiology, 2: 161–173, 1979PubMedCrossRefGoogle Scholar
  4. 4.
    Frais MA, Botvinick EH, Shosa DW, et al: Phase image characterization of ventricular contraction in left and right bundle branch block.Am J Cardiol 50: 95–105, 1982PubMedCrossRefGoogle Scholar
  5. 5.
    Botvinick EH, Frais MA, Shosa DW, et al: An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis.Am J Cardiol 50: 289–298, 1982PubMedCrossRefGoogle Scholar
  6. 6.
    Underwood SR, Walton S, Laming PJ, et al: Patterns of ventricular contraction in patients with conduction abnormality studied by radionuclide angiocardiography.Br Heart J 51: 568–574, 1984PubMedCrossRefGoogle Scholar
  7. 7.
    Botvinick EH, Frais M, O’Connell W, et al: Phase image evaluation of patients with ventricular preexcitation syndromes.J Am Coll Cardiol 3: 799–814, 1984PubMedCrossRefGoogle Scholar
  8. 8.
    Ratib O, Henze E, Schon H, et al: Phase analysis of radionuclide ventriculograms for the detection of coronary artery disease.Am Heart J 104: 1–12, 1982PubMedCrossRefGoogle Scholar
  9. 9.
    Pavel DG, Zimmer AM, Patterson VN:In vivo labeling of red blood cells with Tc-99m: A new approach to blood pool visualization.J Nucl Med 18: 305–308, 1977PubMedGoogle Scholar
  10. 10.
    Kastor JA, Goldreyer BN, Moore N, et al: Intraventricular conduction in man studied with an endocardial electrode catheter mapping technique.Circulation 51: 786–796, 1975PubMedGoogle Scholar
  11. 11.
    Castellanos AJ, Agha AS, Befeler B, et al: A study of arrival of excitation at selected ventricular sites during human bundle branch block using close bipolar electrodes.Chest 63: 208–213, 1973PubMedCrossRefGoogle Scholar
  12. 12.
    Hotta S: The sequence of mechanical activation of the ventricle.Jpn Circ J 31: 1568–1572, 1967PubMedGoogle Scholar
  13. 13.
    Clayton PD, Bulawa WF, Klausner SC, et al: The characteristic sequence for the onset of contraction in the normal human left ventricle.Circulation 59: 671–679, 1979PubMedGoogle Scholar
  14. 14.
    Pavel D, Swiryn S, Lam W, et al: Ventricular phase analysis of radionuclide gated studies. (Abst)Am J Cardiol 45: 398, 1980CrossRefGoogle Scholar
  15. 15.
    Swiryn S, Pavel D, Byrom E, et al: Sequential regional phase mapping of radionuclide gated biventriculograms in patients with left bundle branch block.Am Heart J 102: 1000–1010, 1981PubMedCrossRefGoogle Scholar
  16. 16.
    Tamaki N, Mukai T, Ishii Y, et al: Quantitative evaluation of asynchrony of the left ventricle using phase analysis.Kakuigaku 18: 1241–1248, 1981 (abstract in English)Google Scholar
  17. 17.
    Matsushima H, Kawai N, Suzuki A, et al: The clinical usefulness of the phase analysis of Tc-99m blood-pool imaging in patients with old myocardial infarction complicated with bundle branch block.Kakuigaku 23: 801–809, 1986 (abstract in English)Google Scholar
  18. 18.
    Takeda K, Maeda H, Yamaguchi N, et al: Fourier analysis of multi-gated blood-pool data in patients with congenital heart disease.Kakuigaku 20: 803–814, 1983 (abstract in English)Google Scholar
  19. 19.
    Takeda K: Ventricular performance in congenital left-to-right shunt: Temporal Fourier analysis of gated blood-pool data.J Nucl Med 24: 829–834, 1983PubMedGoogle Scholar
  20. 20.
    Rosenbush SW, Ruggie N, Turner DA, et al: Sequence and timing of ventricular wall motion in patients with bundle branch block.Circulation 66: 1113–1119, 1982PubMedGoogle Scholar
  21. 21.
    Weissler AM, Harris WS, Schoenfeld CD: Systolic time intervals in heart failure in man.Circulation 37: 149–159, 1968PubMedGoogle Scholar
  22. 22.
    Durrer D, Van Dam RT, Freud GE, et al: Total excitation of the isolated human heart.Circulation 41: 899–912, 1970PubMedGoogle Scholar
  23. 23.
    Amer NS, Stuckey JH, Hoffman BF, et al: Activation of the interventricular septal myocardium studied during cardiopulmonary bypass.Am Heart J 59: 224–237, 1960PubMedCrossRefGoogle Scholar
  24. 24.
    Sugiura M, Okada R, Hiraoka K, et al: Histological studied on the conduction system in 14 cases of right bundle branch block associated with left axis deviation.Jpn Heart J 10: 121–132, 1969PubMedGoogle Scholar
  25. 25.
    Ohkawa S: An electrocardiographic and histological correlation study on atrioventricular conduction disturbances in the aged.The Tokyo J of Medical Science 85: 143–166, 1978Google Scholar
  26. 26.
    Scher AM: Excitation of the heart. In Handbook of physiology, Section 2.Circulation 1: 287, 1962Google Scholar
  27. 27.
    Rosenbaum MB, Elizari MV, Lazzari JO: Los hemibloqueos. Buenos Aires, Ed Paidos, 1968Google Scholar
  28. 28.
    Rosenbaum MB: Types of left bundle branch block.J Electrocardiol 2: 197–206, 1969PubMedCrossRefGoogle Scholar
  29. 29.
    Rosenbaum MB: The hemiblock: diagnostic criteria and clinical significance.Mod Concepts Cardiovasc Dis 39: 141–146, 1970PubMedGoogle Scholar
  30. 30.
    Kulbertus HE: Concept of hemiblocks revisited: A histological and experimental study.Adv Cardiol 14: 126–135, 1975PubMedGoogle Scholar
  31. 31.
    Massing GK, James TN: Anatomical configuration of the His bundle and bundle branches in the human heart.Circulation 53: 609–621, 1976PubMedGoogle Scholar
  32. 32.
    Demoulin J, Simar LJ, Kulbertus HE: Quantitative study of left bundle branch fibrosis in left anterior hemiblock; A stereologic approach.Am J Cardiol 36: 751–756, 1975PubMedCrossRefGoogle Scholar
  33. 33.
    Sakurai M, Watanabe Y, Kondo T, et al: Left axis deviation investigated by body surface mapping and phase image analysis.J Cardiography 16: 207–216, 1986 (abstract in English)Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • Tohoru Takeda
    • 1
  • Hinako Toyama
    • 2
  • Kaname Iida
    • 1
  • Takeshi Masuoka
    • 1
  • Ryuichi Ajisaka
    • 1
  • Keisuke Kuga
    • 1
  • Motohiro Satoh
    • 1
  • Shinji Sugahara
    • 1
  • Wu Jin
    • 1
  • Nobuyoshi Ishikawa
    • 1
  • Yasuro Sugishita
    • 1
  • Takao Akatsuka
    • 3
  1. 1.Institute of Clinical MedicineUniversity of TsukubaIbaraki-kenJapan
  2. 2.Tokyo Metropolitan Institute of GerontologyTokyoJapan
  3. 3.Department of Information EngineeringUniversity of YamagataYamagataJapan

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