Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia

Barbara J. Drew, Michele M. Pelter, Donald E. Brodnick, Anil V. Yadav, Debbie Dempel, Mary G. Adams

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

In a few patients, 12-lead electrocardiograms (ECGs) derived from reduced-lead-set configurations do not match the standard ECG. Constructing an ECG from a reduced number of standard leads should minimize this problem because some of the resultant 12 leads would always include "true" standard leads. The purpose of this study was to compare the ability of a new reduced-lead-set 12-lead ECG ("interpolated" ECG) with the standard ECG to diagnose cardiac arrhythmias and acute myocardial ischemia. The interpolated ECG uses six standard electrode sites (limb leads plus V1 and V5), from which the remaining four precordial leads (V2, V3, V4, and V6) are constructed. Standard and interpolated ECGs were compared using data from 2 prospective clinical trials involving 649 patients evaluated for 1) chest pain in the emergency department (ischemia group, n = 509) or 2) tachycardias in the cardiac electrophysiology laboratory (arrhythmia group, n = 140). Diagnoses were identical between standard and interpolated ECGs for bundle branch and fascicular blocks, left atrial enlargement, right ventricular hypertrophy, prior inferior myocardial infarction (MI), and the distinction of ventricular tachycardia from supraventricular tachycardia with aberrant conduction. There was 99% agreement for prior anterior MI (kappa, .935, P = .000). The percent agreement for acute myocardial ischemia on the initial ECG recorded in chest-pain patients in the emergency department was 99.2 % (kappa, .978, P = .000). Of the 120 patients who had ST events with continuous standard 12-lead ECG monitoring, 116 (97%) also had criteria for transient ischemia with the interpolated ECG (ie, δAST ≥ 100 μV in ≥1 lead(s) lasting ≥1 minute(s). The interpolated 12-lead ECG is comparable to the standard ECG for diagnosing multiple cardiac abnormalities, including wide-QRS-complex tachycardias and acute myocardial ischemia. The advantages of this ECG method are that the standard electrode sites are familiar to clinicians and that eight of the 12 leads are "true" standard leads. Hence, QRS-axis and morphology criteria for diagnosing wide-QRS-complex tachycardia and bundle branch and fascicular blocks are preserved.

Original languageEnglish
Pages (from-to)13-21
Number of pages9
JournalJournal of Electrocardiology
Volume35
Issue numberSUPPL.
DOIs
StatePublished - 2002

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Myocardial Ischemia
Cardiac Arrhythmias
Electrocardiography
Bundle-Branch Block
Tachycardia
Lead
Chest Pain
Hospital Emergency Service
Electrodes
Ischemia
Cardiac Electrophysiology
Inferior Wall Myocardial Infarction
Multiple Abnormalities
Right Ventricular Hypertrophy
Supraventricular Tachycardia
Ventricular Tachycardia
Extremities
Myocardial Infarction
Clinical Trials

Keywords

  • Electrocardiogram
  • Myocardial Infarction
  • Physiological monitoring
  • ST segments

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia. / Drew, Barbara J.; Pelter, Michele M.; Brodnick, Donald E.; Yadav, Anil V.; Dempel, Debbie; Adams, Mary G.

In: Journal of Electrocardiology, Vol. 35, No. SUPPL., 2002, p. 13-21.

Research output: Contribution to journalArticle

Drew, Barbara J. ; Pelter, Michele M. ; Brodnick, Donald E. ; Yadav, Anil V. ; Dempel, Debbie ; Adams, Mary G. / Comparison of a new reduced lead set ECG with the standard ECG for diagnosing cardiac arrhythmias and myocardial ischemia. In: Journal of Electrocardiology. 2002 ; Vol. 35, No. SUPPL. pp. 13-21.
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