Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm

Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring

“…15 It is possible for ischemia to be detected in patients with paced rhythm using the Sgarbossa criteria. 16 However, because those criteria are not as well studied in this subgroup as in patients with left bundle branch block, we elected to code these ECGs as uninterpretable for ischemia.…”

ECG in Acute Myocardial Infarction in the Reperfusion Era

“…Nevertheless, when these are not conclusive for diagnosis, the presence of some ECG criteria, pertaining the ST shift in relation to QRS vectors, may still indicate the diagnosis. To this regard, the ECG should be interpreted using the "rule of appropriate discordance", described by Sgarabossa and colleagues (Sgarbossa, 1996(Sgarbossa, , 1998. They identified three independent electrocardiographic criteria suggesting for STEMI diagnosis in presence of LBBB: ST-segment elevation of at least 1mm that is concordant with the QRS complex; ST-segment depression of at least 1mm in leads V 2 and V 3 ; and ST-segment elevation of at least 5 mm that is discordant with the QRS complex.…”

Paced ECG Morphology – Reveals More than What It Conceals

“…The only ECG criterion with a high specificity and statistical significance for the diagnosis of an acute myocardial infarction was ST segment elevation 5 mm in leads with a negative QRS complex. 3 Shape of the ST segment which exhibit upward convexity are useful in this context. Two other criteria with acceptable specificity were ST elevation 1 mm in leads with concordant QRS polarity and ST depression 1 mm in leads V1, V2, or V3.…”

“…Two other criteria with acceptable specificity were ST elevation 1 mm in leads with concordant QRS polarity and ST depression 1 mm in leads V1, V2, or V3. 3,4 It is important to remember that though these criteria are fairly specific, their sensitivity is low. The ECG criterion with the highest sensitivity for the diagnosis of an acute myocardial infarction was ST segment elevation 5 mm in leads with a negative QRS complex and even this criterion has a sensitivity of only around 50%.…”