From the Guidelines
A wide S wave on an electrocardiogram (ECG) is a significant finding that may indicate right ventricular hypertrophy (RVH), particularly when combined with other ECG criteria such as right axis deviation, tall biphasic R/S complexes, and signs of right atrial abnormality, as suggested by the American Heart Association electrocardiography and arrhythmias committee 1. When evaluating a wide S wave, it's crucial to consider it in the context of other ECG findings and the patient's clinical presentation. The presence of prominent S waves in leads V5 or V6, in addition to ECG criteria for left ventricular hypertrophy (LVH), may suggest biventricular hypertrophy, which has important implications for patient management and prognosis 1. Some key points to consider when interpreting a wide S wave include:
- The width of the S wave reflects the time taken for ventricular depolarization to spread through the myocardium, and prolongation suggests delayed conduction through certain parts of the heart.
- Combined tall R waves and deep S waves in leads V2 to V6, with a combined amplitude greater than 60 mm, may indicate LVH in patients with congenital heart defects and RVH 1.
- Further cardiac evaluation, such as echocardiography, stress testing, or cardiac MRI, may be necessary to determine the underlying cause of the wide S wave and to guide management decisions.
- The clinical significance of a wide S wave depends on the patient's symptoms and overall clinical context, with asymptomatic patients potentially requiring only monitoring, while symptomatic patients may require more urgent evaluation and treatment.
From the Research
Wide S Wave
- A wide S wave in leads I and/or V6 can be an indicator of various cardiac conditions, including right ventricular overload and myocardial disease 2.
- The presence of a prominent S wave in leads I and/or V6 is more frequent in patients with cardiopulmonary diseases than in those without these conditions 2.
- However, this ECG sign is not highly specific for any particular disease, and can be found in conditions such as myocardial hypertrophy and pulmonary diseases 2.
- The relationship between ECG criteria, including S wave patterns, and left ventricular hypertrophy (LVH) has been studied, with findings suggesting that ECG criteria for LVH have low sensitivity for diagnosis confirmed by echocardiography 3.
- Other studies have explored the role of ECG in diagnosing and managing cardiac conditions, including acute coronary syndromes and left ventricular hypertrophy, highlighting the importance of considering clinical context and multiple diagnostic tools 4, 5.