Journal of electrocardiology
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Comparative Study
Accuracy of the EASI 12-lead electrocardiogram compared to the standard 12-lead electrocardiogram for diagnosing multiple cardiac abnormalities.
This study was performed to compare a derived 12-lead electrocardiogram (ECG) using a simple 5-electrode lead configuration (EASI 12-lead) with the standard ECG for multiple cardiac diagnoses. Accurate diagnosis of arrhythmias and ischemia often require analysis of multiple (ideally, 12) ECG leads; however, continuous 12-lead monitoring is impractical in hospital settings. EASI and standard ECGs were compared in 540 patients, 426 of whom also had continuous 12-lead ST segment monitoring with both lead methods. ⋯ Of the 426 patients with ST monitoring, 138 patients had a total of 238 ST events (26, acute infarction; 62, angioplasty-induced ischemia; 150, spontaneous transient ischemia). There was 100% agreement between the 2 methods for acute infarction, 95% agreement for angioplasty-induced ischemia, and 89% agreement for transient ischemia. EASI and standard 12-lead ECGs are comparable for multiple cardiac diagnoses; however, serial ECG changes (eg, T-wave changes) should be assessed using one consistent 12-lead method.
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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 + V3-5R + 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. ⋯ 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.
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In spontaneously beating, isolated guinea pig sinus-atria, veratramine (2.44 microM) slowed the rate of spontaneous depolarization of sinoatrial node cells throughout diastole, markedly slowed the frequency, and often (especially in the presence of high extracellular Ca2+) induced a periodic rhythm. This rhythm consisted of periods of complete inactivity (inactive phases) alternating with periods of apparently normal beating (active phases), with a rising and falling (parabolic) frequency pattern like that of neuronal burst firing. Slight mechanical deformation of the sinoatrial node markedly attenuated the effects of veratramine, and periodic rhythm could not be produced when the sinoatrial node was pinned down for immobilization. ⋯ The effects of various programs of electrical stimulation and pacing indicated that activity of the sinoatrial node, whether spontaneous or driven, has two effects on the amplitude of afterdepolarization, a short-lasting cumulative facilitory effect and a long-lasting cumulative inhibitory effect. Veratramine periodic rhythm arises from the interplay of these two effects, with abrupt cessation of beating whenever the afterdepolarization amplitude falls below the threshold for triggering an action potential. It is suggested that the inhibitory effect may be due to inactivation of the slow inward current and the facilitory effect may be due to one or more of the depolarizing currents activated by intracellular Ca2+.
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The introduction of dual-chamber sensing in implantable cardioverter defibrillators (ICDs) has greatly reduced the incidence of false detection due to supraventricular tachycardias. The remaining arrhythmias which serve to confound classification are supraventricular tachycardias (SVTs) with 1:1 anterograde conduction and ventricular tachycardias (VT) with 1:1 retrograde conduction. An algorithm has been designed and tested (28 patients) which employs ventriculoatrial (VA) conduction measurements to separate 1:1 VTs from 1:1 SVTs. ⋯ VA boundaries of 80 ms to 234 ms classified 1:1 VT with 100% sensitivity (SENS) and 80% specificity (SPEC). In addition, the lower boundary completely classified AVNRT with 100% SENS and 100% SPEC, and all passages of ST were contained above the upper boundary. These findings could be of importance in algorithms for next-generation implantable cardioverter defibrillators which include two-chamber (atrial and ventricular) sensing and two-chamber interval measurements.