Electrocardiographic changes during prolonged coronary artery occlusion in man: comparison of standard and...

Detection of acute myocardial ischaemia using electrocardiographic methods is generally based on assessment of the ST segments in the standard 12-lead electrocardiogram (ECG). Several studies have also shown changes in high-frequency QRS components during acute ischaemia. The purpose of the present study was to determine the changes in high-frequency QRS components during prolonged percutaneous transluminal coronary angioplasty (PTCA) and to compare these changes with ST-segment deviations in the standard 12-lead ECG. The study population consisted of 19 patients receiving prolonged PTCA. Standard and high-resolution signal-averaged ECGs were recorded before and during balloon inflation. The high-resolution recordings were performed using bipolar X, Y and Z leads. The QRS complexes in the high-resolution signal-averaged ECGs were analysed within a bandwidth of 150-250 Hz. During inflation, significant reductions in high-frequency QRS components were observed (12-72%). Changes in the high-frequency QRS components were seen in four of the patients without ST-segments deviation in the standard ECG. The correlation between the ST-segment deviation and the reduction in high-frequency QRS components was weak (r = 0.27). Acute coronary artery occlusion produces changes in high-frequency QRS components, even in the absence of ST-segment deviation in the standard ECG. Further studies need to be carried out to evaluate whether analysis of high-frequency QRS components could provide a method for detecting myocardial ischaemia and give additional information to that available in the ST segment in the standard ECG.