[Pseudoischemic ST-segment due to atrial repolarization during exercise test. Review of the literature, diagnostic criteria and personal experience].
Atrial repolarization wave has been known since many years: it is opposite in direction to P wave, may have a magnitude of 100 to 200 microV and may extent into the ST segment (usually it is hidden in the QRS complex). It was hypothesized that this wave could cause ST-segment depression mimicking myocardial ischemia. The false positive response is characterized by marked downsloping of the PR segment at peak exercise, longer exercise time (> 6 min), peak exercise heart rate > 125 bpm, absence of chest pain and ST-segment normalization in the first minute of recovery. In our experience a role of atrial repolarization in ST-segment depression was found in 5.5% of 144 consecutive and non-selected individuals evaluated with exercise testing.
Slavich
Gianaugusto
G
S.O.C. di Cardiologia, Dipartimento di Scienze Cardiopolmonari, A.O. S. Maria della Misericordia, Udine. gianaugustoslavich@virgilio.it
Tuniz
Duilio
D
Fregolent
Rudy
R
Slavich
Massimo
M
D004562:Electrocardiography; D005080:Exercise Test; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology*