Skip to main content
  • Oral presentation
  • Open access
  • Published:

Does MRI lend insight into septal enhancement patterns? The significance of conduction defects on EKG


Interventricular conduction delay is a progressive problem and in patients with heart failure it portents a poor prognosis, especially LBBB. However, the myopathological etiology of IVCD remains poorly understood. Cardiac MRI (CMR) is a very sensitive method to delineate myocardial tissue abnormalities due to inflammation, ischemia, infarction or infiltration, and the relationship of the presence of any abnormal septal delayed hyperenhancement (DHE) to the conduction system may be important.


We hypothesize that patients with conduction disorders on EKG will uniformly have abnormal myocardial septal DHE by CMR.


A study of 215 consecutive pts with DHE CMRI performed in the last 18 months and their most proximate EKG was analyzed for QRS duration, LBBB, RBBB and interventricular conduction delay (IVCD) pattern. The DHE image was analyzed for the presence (+) or absence (-) of any basal anterior or anteroseptal enhancement.


Of the 215 patients, 175 patients' EKG's were available within 1 month. Of those, 71 (40%) had a conduction defect on EKG: 19 patients (11%) had LBBB, 25 (14%) had RBBB and 27 (15%) had IVCD. Of those, 11% of the DHE+ pts had LBBB, as did 11% of the DHE- pts (p = NS). Similarly, 13% of DHE+ pts had RBBB while 16% of DHE- pts had RBBB (p = NS). Likewise, 20% of DHE+ pts had IVCD while 11% of DHE- pts had IVCD (p = NS). Fully 50/86 (58%) of DHE+ patients showed some type of EKG abnormality (RBBB, LBBB or IVCD), along with 64/89 (72%) of DHE- also revealing some level of conduction abnormality (χ2 = 3.07, 1 df, p = .08).


Counterintuitively, despite the high resolution capabilities of CMR, the presence or absence of DHE signal does not influence the EKG conduction pattern, suggesting that infarct patterns affect mechanical but not electrical properties within the heart. The conduction system appears to be relatively 'immune' to disorders typically depicted by resolved infarct imaging. We show for the first time that infarct presence or absence does not materially predict either presence, absence or even type of conduction disorder.

Author information

Authors and Affiliations


Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and permissions

About this article

Cite this article

Caruppannan, K., Vido, D.A. & Biederman, R.W. Does MRI lend insight into septal enhancement patterns? The significance of conduction defects on EKG. J Cardiovasc Magn Reson 12 (Suppl 1), O22 (2010).

Download citation

  • Published:

  • DOI: