Highlights
- •There is lack of evidence on the ECG diagnosis of prior MI during septal pacing.
- •The Cabrera sign is the most useful ECG criterion of prior MI during pacing.
- •Septal pacing does not influence the predictive performance of the Cabrera sign.
Abstract
Background
Electrocardiographic (ECG) identification of prior myocardial infarction (MI) during
right ventricular (RV) pacing is of clinical importance. Proposed ECG criteria have
been evaluated only during apical pacing. We evaluated the effect of pacing site on
the predictive performance of ECG signs of prior MI.
Methods
The present study is a secondary analysis of a prospective, multicenter study which
randomized recipients of an implantable cardioverter defibrillator to an apical versus
septal RV lead positioning. ECGs of patients with or without prior MI were analyzed
for the presence of the following criteria: Cabrera sign, Chapman sign, QR pattern
in leads I, aVL, V5 or V6, QR in inferior leads and notching in the descending slope
of the QRS complex in inferior leads.
Results
The MI group included 89 patients (55.1% apically paced), while 99 patients had no
prior MI (50.5% apically paced). In the total population, the Cabrera sign presented
the highest specificity (97%) and diagnostic accuracy (62.2%), with a sensitivity
of 23.6%. The Cabrera sign was the only significant predictor of a prior MI [OR = 9.9, (95%CI:2.8–34.5), p < 0.001], among all ECG markers. Pacing site did not significantly influence the sensitivity
and specificity of the Cabrera sign for detection of prior MI.
Conclusions
In our study, the Cabrera sign was the only ECG marker that predicted the presence
of prior MI during ventricular paced rhythm. Septal RV lead positioning did not affect
the predictive performance of the Cabrera sign.
Keywords
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Article info
Publication history
Published online: October 04, 2014
Accepted:
September 28,
2014
Received in revised form:
September 24,
2014
Received:
August 12,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
