| Changes in QRS duration and R-wave amplitude in electrocardiogram leads with ST segment elevation differentiate epicardial and transmural myocardial injury. | |
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MedLine Citation:
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PMID: 20633701 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: Acute transmural ischemia increases QRS duration and R-wave amplitude owing to depressed intramyocardial activation. Theoretically, when myocardial injury is confined to the epicardium, the intramyocardial activation is preserved without affecting QRS duration. OBJECTIVE: The purpose of this study was to distinguish epicardial from transmural myocardial injury based on the analysis of the QRS complex in leads with ST segment elevation. METHODS: Electrophysiological effects of epicardial injury induced by topical application (n = 7) or intrapericardial injection (n = 10) of potassium were assessed in pigs in local electrograms recorded with needles in the left ventricle and in the peripheral 12-lead electrocardiogram (ECG), respectively, and were compared with transmural injury induced by acute left anterior descending (LAD) occlusion in the same pig. RESULTS: Epicardial application of 50 mM potassium induced ST segment elevation in epicardial (0.2 ± 0.06 to 0.5 ± 0.09 mV; P <.05) but not in midmyocardial local electrograms (0.1 ± 0.07 to -0.1 ± 0.09 mV). Local midmyocardial activation times were not affected by epicardial applied potassium (182 ± 5.9 vs. 183 ± 5.8 ms) but increased significantly during acute LAD occlusion (246 ± 20.9 ms; P <.01). Intrapericardial injected potassium induced ST segment elevation on average in nine of 12 ECG leads but did not change QRS duration and R-wave amplitude. Acute LAD occlusion induced ST segment elevation (five of 12 leads) associated with increased QRS duration (69 ± 1.2 to 89 ± 3.6 ms; P <.001) and R-wave amplitude (0.1 ± 0.01 to 0.7 ± 0.09 mV; P <.001) in the ECG. CONCLUSION: Transmural but not epicardial myocardial injury delays intramural local activation and is associated with QRS prolongation and enlarged R-wave amplitude in leads with ST segment elevation. This differential ECG pattern may help to distinguish acute pericarditis (epicardial injury) from acute transmural ischemia in clinical practice. |
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Authors:
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Rob F Wiegerinck; Carolina Gálvez-Monton; Esther Jorge; Roser Martínez; Elisabet Ricart; Juan Cinca |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-07-13 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 7 ISSN: 1556-3871 ISO Abbreviation: Heart Rhythm Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-11-02 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 1667-73 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Cardiology, Institute of Biomedical Research (IIB Sant Pau), Autonomous University of Barcelona, Barcelona, Spain. rwiegerinck@santpau.cat |
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Comment In:
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Heart Rhythm. 2010 Nov;7(11):1674-5
[PMID:
20654731
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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