Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction

Author(s)
Scott, Peter J
Navarro, Cesar
Stevenson, Mike
Murphy, John C
Bennett, Johan R
Owens, Colum
Hamilton, Andrew
Manoharan, Ganesh
Adgey, A A Jennifer
Abstract
<p><b>Background:</b> For the assessment of patients with chest pain, the 12-lead electrocardiogram (ECG) is the initial investigation. Major management decisions are based on the ECG findings, both for attempted coronary artery revascularization and risk stratification. The aim of this study was to determine if the current 6 precordial leads (V<sub>1</sub>-V<sub>6</sub>) are optimally located for the detection of STsegment elevation in ST-segment elevation myocardial infarction (STEMI).</p> <p><b>Methods:</b> We analyzed 528 (38% anterior [200], 44% inferior [233], and 18% lateral [95]) patients with STEMI with both a 12-lead ECG and an 80-lead body surface map (BSM) ECG (Prime ECG, Heartscape Technologies, Bangor, Northern Ireland). Body surface map was recorded within 15 minutes of the 12-lead ECG during the acute event and before revascularization. ST-segment elevation of each lead on the BSM was compared with the corresponding 12-lead precordial leads (V<sub>1</sub>-V<sub>6</sub>) for anterior STEMI. In addition, for lateral STEMI, leads I and aVL of the BSM were also compared" and limb leads II, III, aVF of the BSM were compared with inferior unipolar BSM leads for inferior STEMI. Leads with the greatest mean ST-segment elevation were selected, and significance was determined by analysis of variance of the mean ST segment.</p> <p><b>Results:</b> For anterior STEMI, leads V<sub>1</sub>, V<sub>2</sub>, 32, 42, 51, and 57 had the greatest mean ST elevation. These leads are located in the same horizontal plane as that of V<sub>1</sub> and V<sub>2</sub>. Lead 32 had a significantly greater mean ST elevation than the corresponding precordial lead V<sub>3</sub> (<i>P</i> = .012)" and leads 42, 51, and 57 were also significantly greater than corresponding leads V<sub>4</sub>, V<sub>5</sub>, V<sub>6</sub>, respectively (P < .001). Similar findings were also found for lateral STEMI. For inferior STEMI, the limb leads of the BSM (II, III, and aVF) had the greatest mean ST-segment elevation" and lead III was significantly superior to the inferior unipolar leads (7, 17, 27, 37, 47, 55, and 61) of the BSM (P < .001).</p> <p><b>Conclusion:</b> Leads placed on a horizontal strip, in line with leads V<sub>1</sub> and V<sub>2</sub>, provided the optimal placement for the diagnosis of anterior and lateral STEMI and appear superior to leads V<sub>3</sub>, V<sub>4</sub>, V<sub>5</sub>, and V<sub>6</sub>. This is of significant clinical interest, not only for ease and replication of lead placement but also may lead to increased recruitment of patients eligible for revascularization with none or borderline ST-segment elevation on the initial 12-lead ECG.</p>
Citation
Journal of Electrocardiology, 44(4), p. 425-431
ISSN
1532-8430
0022-0736
Link
Publisher
Elsevier Inc
Title
Optimization of the precordial leads of the 12-lead electrocardiogram may improve detection of ST-segment elevation myocardial infarction
Type of document
Journal Article
Entity Type
Publication

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