Body surface distributions of repolarization forces during acute myocardial infarction. I. Isopotential and isoarea...

Although ST-segment abnormalities during acute myocardial infarction are clinically important, the total thoracic distribution of these repolarization potentials has not been reported. To provide this information, 24 patients with acute myocardial infarction were studied. Isopotential body surface maps were constructed from potentials sensed by 150 anterior and posterior electrodes. Patterns from 12 patients with anterior lesions demonstrated the appearance of repolarization potentials 21.3 +/- 4.6 msec before the end of the QRS complex. During the ST segment, potential distributions were characterized by a single anterior maximum that remained fixed in location but increased in intensity as repolarization progressed. Distributions in the remaining subjects with inferior lesions were analogously characterized by (1) the onset of repolarization 34.6 +/- 12.4 msec before termination of the QRS complex and (2) a single anterior minimum located on the left anterior superior thorax, with positive potentials distributed around the lower thoracic margins. These data suggest that electrocardiographic changes after acute myocardial infarction include (1) marked overlap between activation and recovery patterns and (2) isopotential surface patterns with relatively simple topographic configurations, such as expected of a single-dipole equivalent cardiac generator.