Research Article

The Role of Intrinsicoid Deflection Time in Precordial Leads Facing Right Ventricle and aVR for Diagnosis of Acute Pulmonary Thromboembolism and Determination Its Severity


  • Orçun Çiftçi
  • Suzan Keskin
  • Kerem Can Yılmaz
  • Emir Karaçağlar
  • İbrahim Haldun Müderrisoğlu

Received Date: 07.01.2018 Accepted Date: 17.04.2018 J Ankara Univ Fac Med 2018;71(2):135-140


Pulmonary thromboembolism (PTE) is associated with high morbidity and mortality. Recognition of massive and submassive PTE is important for management guidance. Intrinsicoid deflection time refers to the time from QRS onset to the peak of the R wave and corresponds to the spread of conduction from endocardium to epicardium. It has not been used for diagnosis and severity assessment of acute PTE. In this study the role of intrinsicoid deflection times (IDT) in the diagnosis and classification of prognosis of acute PTE.

Materials and Methods:

This study retrospectively included 89 patients who presented to Başkent University Hospital with symptoms compatible with PTE between January 2012 and January 2017. Thirty (33.7%) patients had no PTE, 30 (33.7%) had non-massive and 29 (32.6%) had massive PTE. Twenty (24.7%) patients had clinically mild PTE, 31 (34.8%) had submassive PTE, and 6 (6.7%) had massive PTE. IDT on V1, V2, and aVR of 12-lead electrocardiogram (ECG) were compared between those with and without PTE and between PTE severity groups. IDT on ECG was correlated with clinical, echocardiographic, and biochemical parameters.


Compared to PTE-negative subjects, IDT on lead V2 of ECG was significantly prolonged in PTE-positive patients, angiographically massive and non-massive PTE groups, and clinically massive and submassive groups. On correlation analyses, IDT on lead V2 was significantly correlated with the presence of PTE, angiographic and clinical severity, right ventricular systolic function, and right bundle branch block.


Prolonged IDT on lead V2 is indicative of the presence of PTE, right ventricular dysfunction, and massive and submassive PTE. This parameter should be further studied in future large-scale prospective studies.

Keywords: Pulmonary Embolism, Electrocardiography, Intrinsicoid Deflection Time

Full Text (Turkish)