title: Electrocardiographic identification of prior myocardial infarction during right ventricular pacing--effect of septal versus apical pacing.
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.
authors.affiliation: Henry Dunant Hospital, Department of Cardiology, Athens, Greece. Electronic address: stzeis@otenet.gr.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.affiliation: Henry Dunant Hospital, Department of Cardiology, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.affiliation: Heart Centre Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: Ostalbklinikum, Abteilung für Innere Medizin II, Aalen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Solzbach
authors.affiliation: Dubrava University Hospital, Department of Internal Medicine, Division of Cardiology, University of Zagreb, Zagreb, Croatia.
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Vrazic
authors.affiliation: Klinikum Lüdenscheid, Abteilung für Innere Medizin III, Lüdenscheid, Germany & Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II, Ruhr Universität Bochum, Bochum, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kloppe
authors.affiliation: Universitätsklinikum Leipzig, Abteilung für Kardiologie und Angiologie, Leipzig, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Klein
authors.affiliation: Henry Dunant Hospital, Department of Cardiology, Athens, Greece.
authors.forename: Sokratis
authors.initials: S
authors.lastname: Pastromas
authors.affiliation: Heart Centre Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Biermann
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D054088:Ventricular Septum / Q000503:physiopathology*
keywords: Cabrera sign; Electrocardiography; Myocardial infarction; Pacing; Septal site