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A case of acute myocardial infarction in paced rhythm. Utility of the Barcelona algorithm

Ranganathan R Ramanathan1, Vickram Vignesh Rangaswamy2, T Nanda Kumar3

  • 1Consultant Interventional Cardiologist, Aram Medical Foundation, Pollachi, Coimbatore, India.

Journal of Electrocardiology
|November 17, 2022
PubMed

Insights

A novel algorithm aids in diagnosing acute myocardial infarction in patients with pacemakers. The Barcelona algorithm successfully identified myocardial infarction in a patient with right-ventricular pacing, challenging traditional criteria.

Area of Science:

  • Cardiology
  • Electrocardiography

Background:

  • Standard Sgarbossa and modified Smith criteria are used for diagnosing myocardial infarction (MI) in patients with left bundle branch block (LBBB).
  • Diagnosing MI in patients with pacemaker-induced QRS changes, such as right-ventricular pacing, presents unique electrocardiographic challenges.
  • Atypical chest pain in patients with pacemakers requires careful diagnostic evaluation.

Observation:

  • A 70-year-old male with a pacemaker presented with atypical chest pain.
  • Initial ECGs did not meet Sgarbossa or modified Smith criteria for MI.
  • The recently developed Barcelona algorithm was applied to the patient's ECG.

Findings:

  • The Barcelona algorithm identified electrocardiographic criteria for acute myocardial infarction.
  • Specifically, lead V6 showed a low voltage QRS complex and ST depression, meeting the Barcelona criteria.
  • This diagnosis led to primary angioplasty for in-stent restenosis of the left anterior descending coronary artery.

Implications:

  • This case is the first to report the use of the Barcelona algorithm for diagnosing acute coronary syndrome in a right-ventricular paced rhythm.
  • The findings suggest the Barcelona algorithm may be valuable in diagnosing MI in challenging ECG presentations, including those with pacemakers.
  • Further research is warranted to validate the Barcelona algorithm's utility in pacemaker-dependent rhythms for acute coronary syndrome diagnosis.

Keywords:
Acute myocardial infarctionBarcelona algorithmLBBBPacemakerSgarbossa criteria

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