Changes in QRS duration and R-wave amplitude in electrocardiogram leads with ST segment elevation differentiate epicardial and transmural myocardial injury

Rob F. Wiegerinck, Carolina Glvez-Monton, Esther Jorge, Roser Martnez, Elisabet Ricart, Juan Cinca

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

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. © 2010 Heart Rhythm Society All rights reserved.
Original languageEnglish
Pages (from-to)1667-1673
JournalHeart Rhythm
Volume7
Issue number11
DOIs
Publication statusPublished - 1 Nov 2010

Keywords

  • ECG
  • Ischemia
  • Local electrograms
  • Pericardium
  • Potassium

Fingerprint Dive into the research topics of 'Changes in QRS duration and R-wave amplitude in electrocardiogram leads with ST segment elevation differentiate epicardial and transmural myocardial injury'. Together they form a unique fingerprint.

  • Cite this