Value of a novel 16-lead High-Definition ECG machine to detect conduction abnormalities in structural heart disease

Depolarization abnormalities are hardly detectable by standard 12-lead electrocardiogram (ECG) in some patients.

To evaluate the value of the 16-lead High-Definition (HD)-ECG machine to record conduction abnormalities including Epsilon waves in patients with structural heart disease.

Tracings with 12-lead ECG, 16-lead HD-ECG, and signal-averaged ECG were studied.

(1) Case of severe coronary artery disease (CAD): On 16-lead HD-ECG, a tiny intra-QRS signal was noted in lead III, a prolonged P wave in lead II, and fragmentation on top of lead aVL and lead aVF. Proper automatic measurement of the prolonged P wave measuring 190 ms was noted. Signal-averaging by 16-lead HD-ECG in lead III showed the intra-QRS fragmentation and P wave prolongation of 180 ms. (2) First patient with arrhythmogenic right ventricular dysplasia (ARVD): Standard 12-lead ECG indicated Epsilon waves in lead III, V2, V3, and inverted T waves in V1-V3. 16-lead HD-ECG indicated QRS prolongation in lead II, III, aVL, aVF, V2, V3 as opposed to V6, and low amplitudes of QRS complexes in V4R and V3R as a new possible sign of ARVD. Notches in lead V2, widening of QRS complexes in all precordial leads, but shorter QRS in V8-V9 are also considered as a potential new diagnostic sign of ARVD. (3) Second ARVD patient: Notches at the end of the QRS in lead III and a negative initial deflection of the QRS in V1 and V2 were detected by standard 12-lead ECG. On 16-lead HD-ECG, a more pronounced QRS fragmentation was visible.

16-lead HD-ECG in both CAD and ARVD seems to be more sensitive than 12-lead ECG to record electrocardiographic abnormalities.