Electrocardiographic Appearance of Old Myocardial Infarction in Paced Patients

Abstract

This study evaluated the possibility of diagnosing chronic myocardial infarction in the presence of the pacing electrocardiogram. Forty-five patients with known myocardial infarction (anterior 23, inferior 22) and 26 healthy controls were studied. After coronary angiography, pacing was applied from the right ventricular apex, and the sensitivity, specificity, and average diagnostic accuracy of five criteria on the paced electrocardiogram were assessed: (1) Notching 0.04 second in duration in the ascending limb of the S wave of leads V3, V4, or V5 (Cabrera's sign); (2) Notching of the upstroke of the R wave in leads I, aVL, or V6 (Chapman's sign); (3) Q waves > 0.03 second in duration in leads I, aVL, or V6; (4) Notching of the first 0.04 second of the QRS complex in leads II, III, and aVF; (5) Q wave > 0.03 second in duration in leads II, III, and aVF. The most sensitive criteria, for anterior and inferior myocardial infarctions were Cabrera's and Chapman's (91.1 and 86.6%, respectively). All criteria had low specificity (range 42.3-69.2%). The combination of Cabrera's and Chapman's sign decreased the sensitivity to 77.7%, but increased specificity to 82.2%. The sensitivity and specificity of all the criteria were independent of the myocardial infarction site. In paced patients, the application of electrocardiographic criteria, and especially the combination of Cabrera and Chapman, provides useful clinical information in recognizing prior myocardial infarction but not in assigning the specific infarct site.

Fragmented Wide QRS on a 12-Lead ECG

“…27 In a study of 45 patients with MI (anterior 23, inferior 22) and 26 healthy controls, pacing was applied from the right ventricular apex after coronary angiography. 28 The sensitivity, specificity, and average diagnostic accuracy of the 5 known criteria for MI scar in the presence of paced ECG were assessed. These include (1) All criteria had a low specificity (range, 42.3% to 69.2%).…”

Selective and nonselective His bundle pacing unmasks pathological Q waves on the electrocardiogram

“…In the current case, the His bundle could be paced both selectively (threshold of However, these markers are neither sensitive nor specific and not useful to assess the localization of myocardial infarction [2][3][4]. Of note, neither Cabrera's nor Chapman's sign were present in our patient during any type of pacing, while qR in I and QS in aVL observed during right ventricular pacing were non-diagnostic because of outflow tract/high septal pacing lead position [5].…”

Pace-Ecg in Previous Myocardial Infarction: An Unfinished Story

“…The diagnosis of previous MI in the presence of LBBB, fascicular block, Wolf-Parkinson-White syndrome or right ventricular pacing is challenging and despite several criteria have been proposed, the real diagnostic value of these criteria remains controversial [8][9][10][11]. From these criteria five of them have been studied commonly but results of these studies are controversial and most of them are rather old [6][7][8][9][10][11]. Kochiadakis et al [6] evaluated five criteria for determining previous Abbreviation: ODA -overall diagnostic accuracy.…”

“…From these criteria five of them have been studied commonly but results of these studies are controversial and most of them are rather old [6][7][8][9][10][11]. Kochiadakis et al [6] evaluated five criteria for determining previous Abbreviation: ODA -overall diagnostic accuracy.…”

“…Q wave > 0.03 second in leads II, III, aVF [5]. Limited number of studies evaluated these criteria and revealed low sensitivity but high specificity for the diagnosis of previous MI but these studies are performed in a small number of patients and methods for confirming previous MI are different [6,7]. The aim of this study is to find the predictive value of the five major proposed criteria for MI in pacing ECG of patients with previous MI.…”