A recent recommendation indicates that the QRS complex on routine ECG should be considered abnormal is its duration is of 120ms or more. I saw a young women of 150cm height and 45kg weight with the QRS duration of 110ms and a men of 195cm height and 100kg weight with the QRS duration of 120ms. Actually, who of them had abnormal QRS duration?
Normal QRS width is 70-100 ms; however, a duration of 110 ms in healthy subjects is considered as normal
If you are interested in identifying left bundle branch block you can check these recently proposed criteria that poses different limits for men and women (140 and 130 ms respectively), plus asks for mid QRS notching or slurring in at least 2 contiguous leads.
Am J Cardiol. 2011 Mar 15;107(6):927-34. doi: 10.1016/j.amjcard.2010.11.010.
Defining left bundle branch block in the era of cardiac resynchronization therapy.
Strauss DG1, Selvester RH, Wagner GS.
J Electrocardiol. 2012 Nov-Dec;45(6):635-9. doi: 10.1016/j.jelectrocard.2012.09.001. Epub 2012 Sep 28.
Differentiation between left bundle branch block and left ventricular hypertrophy: implications for cardiac resynchronization therapy.
Strauss DG1.
Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations
Loriano Galeotti, Peter M. van Dam, Zak Loring, Dulciana Chan, David G. Strauss
DOI: http://dx.doi.org/10.1093/europace/eut132 1816-1821 First published online: 23 May 2013
As QRS lenght is not the same in all leads, a question arise: should be the largest one to consider?
Hi Maciej, there is no current consensus on QRS width to be considered abnormal. The MADIT CRT study found increased benefits in female patients paucisymptomatic for heart failure but severe cardiac dysfunction and implanted with CRTD, probably because a wider QRS in smaller body surface area is more detrimental. In that study the QRS duration for enrollment was 150ms, with LBBB morphology.
based upon histrorical criteria, any QRS duration greater than 100 ms is a conduction delay and must be defined according to the conduction system involved or as a nonspecific conduction delay. The interpretation of the ECG is separated from the criteria for improvement with pacing. In the interpretation of the ECG, if the QRS duration is abnormal, you must state that. It is the treating physicians decision as to whether additional therapy will be of value.
Clinically, I would call up to 110 msec (as measured on the widest QRS seen on the ECG) within normal, 110-119 IVCD, and 120 and over either IVCD or LBBB/RBBB (if QRS morphology meets criteria).
Hi Eugene
Many thanks for your concise exhaustive and very helpful answer
marco
I do respect all comments, however the question regards sex-differences and a need for separation of the QRS normal limits in both sexes. Really, did all disussants consider that in the cases exampled the QRS is abnormal is both ?
There is lack of data analysing the effect of gender and also BMI on QRS duration. Because data detailing the effect of gender on QRS duration are still evolving, AHA/ACCF/HRS recommend that for present, a QRS duration of greater that 110 ms in subject older than 16 years old be regarded as abnormal. More studies analysing the effect of gender and also BMI on QRS duration are needed to renew this recommendation.
http://www.ncbi.nlm.nih.gov/pubmed/19281930
I agree with the recommendation and comments of the Cvijic. I also suggest to read "J Am Coll Cardiol. 2009 Mar 17;53(11):976-81. doi: 10.1016/j.jacc.2008.12.013. Practice Guideline; Review".
When I was a student I was taught that >100ms was abnormal. These days >120ms is the cut off value
Hi Richard
I also have in my mind cut-off for normal QRS duration set to 100, whereas >120 ms is for "large" QRS so that over 100 and below 120 is nobody's land.
However one thing is "large" QRS, another thing is bundle branch block ( being for the latter an higher cut off value
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