R wave of the surface and intracoronary electrogram during acute coronary artery occlusion

Feldman, Ted; Chua, K. G.; Childers, Rory

doi:10.1016/s0002-9149(86)80004-2

Cited by 60 publications

(15 citation statements)

References 30 publications

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“…ST segment deviation appears on intracoronary electrograms in the absence of changes on the surface ECG in many patients. However, the reverse is true in some individuals; in a group of ten patients the appearance of ST segment deviation was noted on the intracoronary electrogram before the surface electrocardiogram in seven patients, first on the surface electrocardiogram in one patient, and simultaneously in two patients [3]. Other investigators have reported similar findings [2,4].…”

Section: Introductionmentioning

confidence: 65%

Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Feldman

Childers

Chua

1987

Cathet. Cardiovasc. Diagn.

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During percutaneous transluminal coronary angioplasty (PTCA) frontal ECG leads are routinely monitored. The detection of ST segment deviation during the procedure is important for decisions regarding guiding catheter seating and the timing of balloon inflation and deflation. ST segment deviation appears on intracoronary electrograms in the absence of changes on the surface ECG in many patients, while the reverse is true in some individuals. When a precordial lead is employed, V5 or V6 is most commonly selected. The surface ECG leads most sensitive for monitoring ischemia during left anterior descending angioplasty are not known. In nine lead surface ECGs recorded during balloon inflation, a small degree of ST segment elevation occurred in leads I, aVL, and V5. Lead V2 demonstrated an increase in ST displacement from 0.0 +/- 0.03 mV to 0.29 +/- 0.25 mV during coronary occlusion (p less than 0.01). We conclude that if V5 or V6 is used as a single precordial lead, surface ECG alterations are easily overlooked. During left anterior descending occlusion the most sensitive surface lead is V2. Optimal ECG monitoring during PTCA in some cases should involve surface lead V2 or the intracoronary lead.

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Section: Introductionmentioning

confidence: 65%

Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Feldman

Childers

Chua

1987

Cathet. Cardiovasc. Diagn.

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“…31,32) Hence, only a severe and prolonged ischemia that affects the Purkinje fibers could alter the terminal portion of the QRS complex. While distortion of the QRS complex may represent severe ischemia, the absence of such distortion despite prolonged ischemia may signify myocardial protection.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

et al. 2004

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SUMMARYAlthough the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 ± 2 days later was investigated.Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in ≥ 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V 1 -V 3 ).There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS-group was significantly decreased relative to baseline (from 2.93 ± 0.65 to 2.37 ± 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS-group and 17.8% (27/ 151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS-group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01)From the

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“…1). Conventional ischaemic changes were defined as either ST-segment deviation (either depression or elevation), occurring 60-80 ms after the J point, or T-wave inversion (FELDMAN et al, 1986;F~SCH, 1997;MAIRESSE et al, 1994). The ECG complexes recorded during ACO were compared with their counterparts prior to ACO (termed B3 and defined in Section 2.4.1), which were also compared with ECG complexes from the baseline trace (termed B1 and defined in Section 2.4.1).…”

Section: Standard Visual Analysis Of the Ecgmentioning

confidence: 99%

“…standard body surface ECG has low sensitivity (~50%) for detecting ACO (ABBOUD et al, 1987;FELDMAN et al, 1986;HAUSER et al, 1985;MACDONALD et al, 1994). Sophisticated methods based on analyses of ECG morphology and derived indices increase the sensitivity to more than 80% (ABBoUD et al, 1987;GARCIA et al, 1998;1999;2000).…”

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confidence: 99%

Non-invasive computerised detection of acute coronary occlusion

Dori

Denekamp

Fishman

et al. 2004

Med. Biol. Eng. Comput.

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The goal of this study was to evaluate the role of a computerised, non-invasive ECG method for detecting acute coronary occlusion (ACO). Ninety-five standard ECG leads were recorded, before and during ACO, from 18 patients undergoing balloon angioplasty. ECG amplitude and derivative parameters were calculated for the ORS, ST and T components of the ECG signal, before and during ACO. Results were obtained for each lead. Sensitivity of the standard visual ECG analysis for detecting ACO was 48%, whereas the percentage of conventional ECG changes during baseline was 14%. For the best ECG parameter, the amplitude parameter of the ORS component, sensitivity was 82%, and the percentage of parameter changes during baseline was 20%. The sensitivity for detecting ACO with five of the six ECG parameters studied was greater than that of the standard visual analysis. Ischaemic changes were detected in 4.3 +/- 1.6 leads per patient using the amplitude parameter of the ORS component, whereas, with the standard visual analysis, 2.5 +/- 2.1 leads demonstrated such changes (p<0.001). Results were then summarized per patient. The standard visual ECG analysis detected ACO in 15 of 18 patients (83%), if at least one lead showed ischaemic changes. The computerised analysis detected ACO in all 18 patients using the same criterion. The sensitivity of the computerised method for detecting ACO in the clinical setting of angioplasty was greater than that of the standard visual analysis. It is suggested that the computerised method may be useful for detecting myocardial ischaemia in other clinical settings of acute myocardial ischaemia.

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R wave of the surface and intracoronary electrogram during acute coronary artery occlusion

Cited by 60 publications

References 30 publications

Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

Optimal ECG monitoring during percutaneous transluminal coronary angioplasty of the left anterior descending artery

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

Non-invasive computerised detection of acute coronary occlusion

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