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Abnormal ventricular axis

MedGen UID:
1785810
•Concept ID:
C1112436
•
Finding
Synonym: Abnormal QRS axis
 
HPO: HP:0033566

Definition

Any deviation from the normal direction of the ventricular axis. The left ventricle makes up most of the heart muscle under normal circumstances and therefore generates the most electrical force visible on the EKG. The normal ventricular axis is directed downward and slightly towards the left. The ventricular axis can be determined by analyzing the QRS complex, which represents ventricular depolarization. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAbnormal ventricular axis

Professional guidelines

PubMed

Prenatal Diagnosis and Postnatal Outcome of Eight Cases with Criss-Cross Heart - A Multicenter Case Series.
Vorisek CN, Kurkevych A, Kuhn V, Stessig R, Ritgen J, Degenhardt J, Enzensberger C, Wolter A, Götte M, Khalil M, Akintürk H, Axt-Fliedner R
Ultraschall Med 2022 Dec;43(6):e90-e97. Epub 2020 Jul 16 doi: 10.1055/a-1205-0289. PMID: 32674186
Dilated cardiomyopathy and arrhythmogenic left ventricular cardiomyopathy: a comprehensive genotype-imaging phenotype study.
Augusto JB, Eiros R, Nakou E, Moura-Ferreira S, Treibel TA, Captur G, Akhtar MM, Protonotarios A, Gossios TD, Savvatis K, Syrris P, Mohiddin S, Moon JC, Elliott PM, Lopes LR
Eur Heart J Cardiovasc Imaging 2020 Mar 1;21(3):326-336. doi: 10.1093/ehjci/jez188. PMID: 31317183
Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH
J Am Soc Echocardiogr 2013 Sep;26(9):921-64. doi: 10.1016/j.echo.2013.07.009. PMID: 23998692

Recent clinical studies

Etiology

Electrocardiographic Predictors of Atrial Fibrillation.
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ
Med Sci (Basel) 2023 Apr 7;11(2) doi: 10.3390/medsci11020030. PMID: 37092499Free PMC Article
Ventricular and atrial function and deformation is largely preserved after arterial switch operation.
Schuwerk R, Freitag-Wolf S, Krupickova S, Gabbert DD, Uebing A, Langguth P, Voges I
Heart 2021 Oct;107(20):1644-1650. Epub 2021 Aug 4 doi: 10.1136/heartjnl-2021-319410. PMID: 34349009
Electrocardiographic manifestations of COVID-19.
Long B, Brady WJ, Bridwell RE, Ramzy M, Montrief T, Singh M, Gottlieb M
Am J Emerg Med 2021 Mar;41:96-103. Epub 2020 Dec 29 doi: 10.1016/j.ajem.2020.12.060. PMID: 33412365Free PMC Article
Early Evaluation of the Fetal Heart.
Hernandez-Andrade E, Patwardhan M, Cruz-Lemini M, Luewan S
Fetal Diagn Ther 2017;42(3):161-173. Epub 2017 Jul 5 doi: 10.1159/000477564. PMID: 28675906
Borderline left ventricle.
Corno AF
Eur J Cardiothorac Surg 2005 Jan;27(1):67-73. doi: 10.1016/j.ejcts.2004.10.034. PMID: 15621473

Diagnosis

Electrocardiographic Predictors of Atrial Fibrillation.
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ
Med Sci (Basel) 2023 Apr 7;11(2) doi: 10.3390/medsci11020030. PMID: 37092499Free PMC Article
Electrocardiogram in patients with pulmonary hypertension.
Ley L, Höltgen R, Bogossian H, Ghofrani HA, Bandorski D
J Electrocardiol 2023 Jul-Aug;79:24-29. Epub 2023 Mar 5 doi: 10.1016/j.jelectrocard.2023.02.007. PMID: 36913785
Takotsubo syndrome.
Gupta S, Gupta MM
Indian Heart J 2018 Jan-Feb;70(1):165-174. Epub 2017 Sep 13 doi: 10.1016/j.ihj.2017.09.005. PMID: 29455773Free PMC Article
Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists.
Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, Reeves ST, Shanewise JS, Siu SC, Stewart W, Picard MH
J Am Soc Echocardiogr 2013 Sep;26(9):921-64. doi: 10.1016/j.echo.2013.07.009. PMID: 23998692
The pediatric ECG.
Sharieff GQ, Rao SO
Emerg Med Clin North Am 2006 Feb;24(1):195-208, vii-viii. doi: 10.1016/j.emc.2005.08.014. PMID: 16308120

Therapy

Congenital heart defects caused by FOXJ1.
Padua MB, Helm BM, Wells JR, Smith AM, Bellchambers HM, Sridhar A, Ware SM
Hum Mol Genet 2023 Jul 4;32(14):2335-2346. doi: 10.1093/hmg/ddad065. PMID: 37158461Free PMC Article
T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension.
Assanelli D, Di Castelnuovo A, Rago L, Badilini F, Vinetti G, Gianfagna F, Salvetti M, Zito F, Donati MB, de Gaetano G, Iacoviello L; Moli-sani Project Investigators
J Electrocardiol 2013 Nov-Dec;46(6):487-91. Epub 2013 Sep 6 doi: 10.1016/j.jelectrocard.2013.08.002. PMID: 24011993
Purkinje-related arrhythmias part I: monomorphic ventricular tachycardias.
Nogami A
Pacing Clin Electrophysiol 2011 May;34(5):624-50. Epub 2011 Mar 16 doi: 10.1111/j.1540-8159.2011.03044.x. PMID: 21410719
Tricyclic antidepressant poisoning : cardiovascular toxicity.
Thanacoody HK, Thomas SH
Toxicol Rev 2005;24(3):205-14. doi: 10.2165/00139709-200524030-00013. PMID: 16390222
Tricyclic antidepressant poisoning.
Glauser J
Cleve Clin J Med 2000 Oct;67(10):704-6, 709-13, 717-9. doi: 10.3949/ccjm.67.10.704. PMID: 11060957

Prognosis

Electrocardiographic Predictors of Atrial Fibrillation.
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ
Med Sci (Basel) 2023 Apr 7;11(2) doi: 10.3390/medsci11020030. PMID: 37092499Free PMC Article
Electrocardiogram in patients with pulmonary hypertension.
Ley L, Höltgen R, Bogossian H, Ghofrani HA, Bandorski D
J Electrocardiol 2023 Jul-Aug;79:24-29. Epub 2023 Mar 5 doi: 10.1016/j.jelectrocard.2023.02.007. PMID: 36913785
Ventricular arrhythmias and risk stratification of cardiac sudden death in athletes.
Crescenzi C, Panattoni G, Stazi A, Martino A, Sgueglia M, De Ruvo E, Calò L
Minerva Cardioangiol 2020 Apr;68(2):110-122. doi: 10.23736/S0026-4725.20.05178-6. PMID: 32429629
Takotsubo syndrome.
Gupta S, Gupta MM
Indian Heart J 2018 Jan-Feb;70(1):165-174. Epub 2017 Sep 13 doi: 10.1016/j.ihj.2017.09.005. PMID: 29455773Free PMC Article
The aging electrocardiogram.
Jones J, Srodulski ZM, Romisher S
Am J Emerg Med 1990 May;8(3):240-5. doi: 10.1016/0735-6757(90)90331-s. PMID: 2184809

Clinical prediction guides

Electrocardiographic Predictors of Atrial Fibrillation.
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ
Med Sci (Basel) 2023 Apr 7;11(2) doi: 10.3390/medsci11020030. PMID: 37092499Free PMC Article
Electrocardiogram in patients with pulmonary hypertension.
Ley L, Höltgen R, Bogossian H, Ghofrani HA, Bandorski D
J Electrocardiol 2023 Jul-Aug;79:24-29. Epub 2023 Mar 5 doi: 10.1016/j.jelectrocard.2023.02.007. PMID: 36913785
Prevalence and clinical correlates of exercise-induced ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy.
Finocchiaro G, Barra B, Molaro S, Zampieri M, Monje-Garcia L, Evans C, Ermolao A, Georgiopoulos G, Sheikh N, Bastiaenen R, Roberts L, Masci PG, Sado D, Chiribiri A, Carr-White G
Int J Cardiovasc Imaging 2022 Feb;38(2):389-396. Epub 2021 Sep 4 doi: 10.1007/s10554-021-02395-w. PMID: 34480708
Perioperative assessment of myocardial deformation.
Duncan AE, Alfirevic A, Sessler DI, Popovic ZB, Thomas JD
Anesth Analg 2014 Mar;118(3):525-44. doi: 10.1213/ANE.0000000000000088. PMID: 24557101Free PMC Article
Systolic ventricular filling.
Torrent-Guasp F, Kocica MJ, Corno A, Komeda M, Cox J, Flotats A, Ballester-Rodes M, Carreras-Costa F
Eur J Cardiothorac Surg 2004 Mar;25(3):376-86. doi: 10.1016/j.ejcts.2003.12.020. PMID: 15019664

Recent systematic reviews

ECG predictors of AF: A systematic review (predicting AF in ischaemic stroke-PrAFIS).
Berry-Noronha A, Bonavia L, Song E, Grose D, Johnson D, Maylin E, Oqueli E, Sahathevan R
Clin Neurol Neurosurg 2024 Feb;237:108164. Epub 2024 Feb 11 doi: 10.1016/j.clineuro.2024.108164. PMID: 38377651
Electrocardiographic Predictors of Atrial Fibrillation.
Chousou PA, Chattopadhyay R, Tsampasian V, Vassiliou VS, Pugh PJ
Med Sci (Basel) 2023 Apr 7;11(2) doi: 10.3390/medsci11020030. PMID: 37092499Free PMC Article
The role of central autonomic nervous system dysfunction in Takotsubo syndrome: a systematic review.
Brazdil V, Kala P, Hudec M, Poloczek M, Kanovsky J, Stipal R, Jerabek P, Bocek O, Pail M, Brazdil M
Clin Auton Res 2022 Feb;32(1):9-17. Epub 2022 Jan 8 doi: 10.1007/s10286-021-00844-z. PMID: 34997877Free PMC Article
Coexisting Retrocerebellar Arachnoid Cyst and Chiari Type 1 Malformation: 3 Pediatric Cases of Surgical Management Tailored to the Pathogenic Mechanism and Systematic Review of the Literature.
Di Perna G, Piatelli G, Rossi A, Consales A, Fiaschi P, Castaldo M, Pavanello M
World Neurosurg 2021 Apr;148:44-53. Epub 2020 Dec 29 doi: 10.1016/j.wneu.2020.12.094. PMID: 33385608

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