Electrocardiogram-based false positive diagnosis of left ventricular hypertrophy during tachycardia: What more needs to be done.

This short communication aims at raising an insight about an observation made 26 years ago, describing a transient false positive electrocardiogram (ECG)-based diagnosis of left ventricular hypertrophy (LVH) in patients with various tachycardias (e.g, sinus, supraventricular, atrial fibrillation) with or without evidence of LVH as assessed by cardiac imaging. The mechanism is purported to be due to a tachycardia-mediated shortening of the diastolic left ventricular (LV) dimensions due to tachycardias, with the diastolic LV volume centroid displaced closer to the anterior chest wall (e.g. "Wilson's proximity effect"). This insight prevents an inappropriate diagnosis of LVH; also, it is possible that the absence of such a phenomenon during tachycardias may imply in some cases advanced acute or chronic heart failure, resulting in LV diastolic dilatation, counteracting this ECG phenomenon. The author advocates that automated ECG interpretation algorithms providing interpretation upon recording of an ECG should be modified to reflect on this insight, since many physicians rely inappropriately on the automated ECG interpretation.