PACE-ECG IN PREVIOUS MYOCARDIAL INFARCTION: AN UNFINISHED STORY

Abstract

Aim. The diagnosis of previous myocardial infarction (MI) is difficult in patients with pacemaker and usually further tests must be done to confirm the diagnosis. To overcome this difficulty five major ECG criteria have been proposed by authors: 1. Notching 0.04 second in the ascending limb of the S wave of leads V3,4 or 5 (Cabrera’s sign), 2. Notching of the upstroke of the R wave in leads I, aVL or V6 (Chapman’s sign), 3. Q wave >0.03 second in leads I, aVL or V6, 4. Notching of the first 0.04 second of the QRS complex in leads II, III, aVF, 5. Q wave >0.03 second in leads II, III, aVF. 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. Material and methods. Twenty- three pacemaker patients with known MI (anterior 15, inferior 8) and 24 healthy pacemaker control patients; 17 female, 30 males, aged between 17-92 years with mean age of 59,5 ± 20 years, total 47 patients were studied. Documentation and localization of MI was based on history and confirmed by angiography and or scintigraphy. Results. Sensitivity was lower in all parameters for prediction of any MI whereas specificity was higher and ODA was moderate. Cabrera’s and Chapman’s sign had moderate sensitivity (60%-60%) whereas high specificity (90%-90%) and ODA (81%-81%) for anterior MI. Sensitivity of Q wave in I, aVL or V6 was lower (47%) for anterior MI but specificity and ODA was higher 84% and 92% respectively. Conclusion. In conclusion Cabrera’s and Chapman’s sign have a moderate sensitivity and higher specificity for recognising previous anterior MI in pacing patients.