Comparison of 18-lead ECG and selected body surface potential mapping leads in determining maximally deviated ST lead and efficacy in detecting acute myocardial ischemia during coronary occlusion

Shu Fen Wung, Barbara Drew

Research output: Contribution to journalArticle

24 Scopus citations

Abstract

Kornreich identified 6 body surface potential mapping (BSPM) leads outside the standard 12-lead electrocardiographic (ECG) sites for optimal recognition of ST segment elevation (+) and depression (-) during acute ischemia in anterior, inferior, and posterior myocardial zones (A+, A-, I+, I-, P+, P-). No comparison has been made between the 6 selected BSPM leads and 18-lead ECG (12 + V(3-5R) + V7-9) in detecting acute myocardial ischemia during coronary occlusion. Continuous 18-lead ECG and 6 selected BSPM leads were recorded in 68 patients (77 vessels) undergoing coronary angioplasty during balloon occlusion. Ischemia was defined as ST segment deviation (ΔST) ≥ 100 μV ≥ 1 lead from the preinflation baseline. The 18- lead ECG was a more frequent source of the maximal ΔST lead during left anterior descending artery, right coronary artery, and left circumflex artery occlusion (71 [92%]) than the 6 selected BSPM leads (5 [7%]). The 18-lead ECG was more efficacious than the 6 selected BSPM leads for detecting acute myocardial ischemia in the group as whole. The 18-lead ECG was also more efficacious for detecting right ventricular ischemia associated with proximal right coronary artery occlusion and for detecting ST segment elevation during left circumflex artery occlusion. Our findings indicate that the 18-lead ECG is the most frequent source of maximally deviated lead and is more efficacious in detecting myocardial ischemia during balloon occlusion than the 6 selected BSPM leads. The 6 selected BSPM leads do not add information above and beyond the 12- or 18-lead ECG, and thus cannot be recommended as optimal sites for continuous ST segment monitoring of patients with acute coronary syndromes.

Original languageEnglish (US)
Pages (from-to)30-37
Number of pages8
JournalJournal of Electrocardiology
Volume32
Issue numberSUPPL.
DOIs
StatePublished - Jan 1 1999
Externally publishedYes

Keywords

  • 18-lead ECG
  • Acute myocardial ischemia
  • Body surface potential mapping
  • ST segment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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