Electrocardiographic ST-segment monitoring during controlled occlusion of coronary arteries

Haeberlin, Andreas; Studer, Evelyn; Niederhauser, Thomas; Stoller, Michael; Marisa, Thanks; Götte, Josef; Jacomet, Marcel; Traupe, Tobias; Seiler, Christian; Vogel, Rolf (2014). Electrocardiographic ST-segment monitoring during controlled occlusion of coronary arteries. Journal of electrocardiology, 47(1), pp. 29-37. Elsevier 10.1016/j.jelectrocard.2013.10.003

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Background: Ischemia monitoring cannot always be performed by 12-lead ECG. Hence, the individual performance of the ECG leads is crucial. No experimental data on the ECG's specificity for transient ischemia exist.

Methods: In 45 patients a 19-lead ECG was registered during a 1-minute balloon occlusion of a coronary artery (left anterior descending artery [LAD], right coronary artery [RCA] or left circumflex artery [LCX]). ST-segment shifts and sensitivity/specificity of the leads were measured.

Results: During LAD occlusion, V3 showed maximal ST-segment elevation (0.26 mV [IQR 0.16–0.33 mV], p = 0.001) and sensitivity/specificity (88% and 80%). During RCA occlusion, III showed maximal ST-elevation (0.2 mV [IQR 0.09–0.26 mV], p = 0.004), aVF had the best sensitivity/specificity (85% and 68%). During LCX occlusion, V6 showed maximal ST-segment elevation (0.04 mV [IQR 0.02–0.14 mV], p = 0.005), and sensitivity/specificity was (31%/92%) but could be improved (63%/72%) using an optimized cut-off for ischemia.

Conclusion: V3, aVF and V6 show the best performance to detect transient ischemia.

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