16-lead ECG changes with coronary angioplasty. Location of ST-T changes with balloon occlusion of five arterial perfusion beds
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H A Saetre1, R H Selvester, J C Solomon
1Memorial Heart Institute of Long Beach, California.
Insights
This study shows that using more electrocardiogram (ECG) leads during percutaneous transluminal coronary angioplasty (PTCA) improves the detection of heart injury. Additional ECG leads accurately pinpoint ST elevation, indicating improved sensitivity for detecting ischemia during PTCA.
Area of Science:
- Cardiology
- Medical Imaging
- Electrophysiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure to treat coronary artery blockages.
- Standard electrocardiogram (ECG) monitoring may not always detect subtle ischemic changes during PTCA.
- The
- current of injury
- manifests as ST elevation on ECG, indicating myocardial ischemia.
Purpose of the Study:
- To evaluate the diagnostic utility of an expanded 16-lead ECG array during PTCA.
- To determine if additional torso and limb leads can improve the localization and detection of ST elevation during coronary artery occlusion.
- To assess the correlation between specific lead ST elevations and the affected coronary artery distribution.
Main Methods:
- A 16-lead ECG system was employed, including standard limb and precordial leads, plus four additional torso leads (left axilla, left subcostal, V8, midback).
- ST elevation was recorded during PTCA occlusions in five coronary artery distributions in 46 patients.
- ECG lead data were analyzed for ST elevation localization and correlation with the occluded artery.
Main Results:
- Significant ST elevation was observed in 96% of PTCA occlusions.
- Additional torso leads, particularly left axillary and midback, effectively discriminated between diagonal and left circumflex artery occlusions.
- Specific leads showed high sensitivity for certain coronary territories: V6 for left circumflex (100%) and V3R for right coronary (82%).
Conclusions:
- An expanded 16-lead ECG array significantly enhances the detection and localization of myocardial ischemia during PTCA.
- The use of additional torso leads provides greater sensitivity and specificity compared to standard ECG configurations.
- These findings support the hypothesis that a broader array of ECG leads improves diagnostic resolution for ischemic events during interventional cardiology procedures.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) occlusion in five individual coronary artery distributions produced significant ST elevation ("current of injury") in 48/50 PTCAs in 46 patients. Four patients had PTCA of two separate coronary arteries. Two patients had no significant ischemic ST changes in the 16 simultaneous lead ECG and no chest pain with PTCA. The six limb leads were recorded from Mason-Likar locations modified by moving them centrally on the anterior torso; the V leads were recorded in standard locations, except V1 was moved to V3R. Four extra leads were placed as follows: (1) left axilla, (2) left subcostal margin, (3) V8, and (4) midback at the level of V4-V8. The left axillary and back leads discriminated diagonal and left circumflex (LCX) PTCAs from the others and from each other. V6 showed ST elevation in all LCX PTCAs and in only 10% of left anterior descending occlusions. V3R showed ST elevation in 82% of right coronary PTCAs. In 48/50 (96%) of PTCA occlusions the ST elevation was localized to the torso locations defined in Forward Model Simulations as specific for the arterial perfusion bed involved. These data strongly support the hypothesis that additional resolution and sensitivity to ischemic change is to be expected with a broader array of ECG leads.