Ventricular injury in acute left circumflex occlusion: Exploration using precordial bipolar leads and regional vectorcardiograms

Mario J Mc Loughlin; José M Di Diego

doi:10.1016/j.jelectrocard.2024.03.012

Ventricular injury in acute left circumflex occlusion: Exploration using precordial bipolar leads and regional vectorcardiograms

J Electrocardiol. 2024 Mar 28:84:81-87. doi: 10.1016/j.jelectrocard.2024.03.012. Online ahead of print.

Authors

Mario J Mc Loughlin¹, José M Di Diego²

Affiliations

¹ Centro de Investigaciones Médicas Florida, Buenos Aires, Argentina (MJML) and Lankenau Institute for Medical Research, Wynnewood, PA, USA. Electronic address: mario.mcloughlin@gmail.com.
² Centro de Investigaciones Médicas Florida, Buenos Aires, Argentina (MJML) and Lankenau Institute for Medical Research, Wynnewood, PA, USA.

PMID: 38574634
DOI: 10.1016/j.jelectrocard.2024.03.012

Abstract

Background: Precordial Bipolar Leads (PBLs) provide new electrocardiographic information derived from standard 12‑lead ECG recordings.

Objectives: To explore the usefulness of PBLs in patients with acute circumflex coronary artery (CxCA) occlusion.

Methods: Twelve patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA) were studied before and after acute CxCA occlusion and their data were processed with new methods based on PBLs.

Results: The findings were: 1. In right PBL V2-V1, a strong systolic current of injury moving in the left-to-right direction coexists with a strong right-to-left current of injury displayed in left standard unipolar precordial leads (V4, V5 and V6). 2. Ischemic changes lead to a significant increase (approximately 10 ms) in the QRS duration in different leads, although changes in the QRS loop rotation and folding were absent. 3. In the transverse, sagittal, and frontal planes, superimposing two PBLs and the corresponding Regional VCG facilitates the location of the J-point. 4. In the Regional VCGs of this group of patients, J-point and ST segment shifts produced an image that reminds the Greek letter omega (Ω). 5. The currents of injury flowing in opposite directions could result in electrical cancellation that minimizes ECG changes in the standard 12‑lead recordings.

Conclusions: Computerized processing of digital, standard 12‑lead ECG recordings, provides new valuable diagnostic data in patients with acute CxCA occlusion. The loops revealed important information related to systolic currents of injury. Because these methods use routine 12‑lead ECG data, the procedure is based only in software applications.

Condensed abstract: Twelve patients undergoing PTCA were studied before and after acute CxCA occlusion and their data were processed with the new methods based on Precordial Bipolar Leads (PBLs) to explore their usefulness. The results showed strong systolic currents of injury in different and sometimes opposite directions in the right-to-left axis and ischemic alterations in the time and amplitude of the QRS waves. The superimposition of two-dimensional coordinates planes (x-y, x-z or z-y) helped to locate the J-point and to display the Regional VCG omega sign (Ω) of myocardial injury. In conclusion, computerized processing of digital ECG data provides new diagnostic information in patients with acute CxCA occlusion.

Keywords: Acute myocardial infarction; Current of injury; Electrocardiography; Electrophysiology; Myocardial ischemia.