ECG LVH voltage criteria & Romhilt-Estes

Applies the common ECG voltage criteria for left ventricular hypertrophy and shows which remain valid with the conduction pattern present: RBBB-specific (Vandenberg) criteria, the Klein criterion for LBBB and the Gertsch criterion for left anterior fascicular block. Supportive findings (left atrial abnormality, strain, left axis deviation) are reported alongside and scored with the Romhilt-Estes point system.

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Sex

Cornell and Peguero-Lo Presti use sex-specific thresholds

Intraventricular conduction

Bundle branch and fascicular blocks change which criteria are valid

Precordial leads

Amplitudes in mm at 10 mm/mV; enter S-wave depths as positive numbers

S in V1

S in V3

S in V4

R in V5

R in V6

Limb leads and QRS

R in aVL

R in I

S in III

Deepest S, any lead

Peguero-Lo Presti (SD)QRS duration

Supportive findings

Also scored in the Romhilt-Estes point score

Romhilt-Estes point score

Voltage and QRS ≥ 90 ms are taken from the amplitudes above; ≥ 5 definite, 4 probable LVH

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ECG left ventricular hypertrophy

Enter lead amplitudes to apply the voltage criteria and the Romhilt-Estes score.

References

Hancock EW, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: Part V — chamber hypertrophy. Circulation 2009;119:e251-e261.
Sokolow M, Lyon TP. The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949;37:161-186.
Casale PN, et al. Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987;75:565-572.
Peguero JG, et al. Electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. J Am Coll Cardiol 2017;69:1694-1703.
Klein RC, et al. Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block. Am Heart J 1984;108:502-506.
Romhilt DW, Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 1968;75:752-758.
Vandenberg B, Sagar K, Paulsen W, Romhilt D. Electrocardiographic criteria for diagnosis of left ventricular hypertrophy in the presence of complete right bundle branch block. Am J Cardiol 1989;63:1080-1084.