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Diagnosis of Occlusion Myocardial Infarction in Patients with Left Bundle Branch Block and Paced Rhythms

  • Management of Acute Coronary Syndromes (H Jneid, Section Editor)
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Abstract

Purpose of Review

A number of criteria have been developed to aid with the diagnosis of occlusion myocardial infarction (OMI) in patients with left bundle branch block (LBBB) and ventricular paced rhythms (VPR). The current guidelines do not provide clear preference for any specific ECG criteria in LBBB and paced rhythm patients.

Recent Findings

This review delineates the difficulties of electrocardiographic diagnosis of OMI in both LBBB and VPR patients. We describe the original Sgarbossa and the newer criteria and their diagnostic performances. We highlight the expected changes of newer pacing modalities and how they may interfere with the electrocardiographic diagnosis of OMI.

Summary

We recommend utilizing the Cai et al. algorithm, which combines clinical assessment with the Smith Modified Sgarbossa ECG criteria, for both LBBB and right ventricular pacing patients with suspected OMI. There is limited data concerning ECG changes of OMI in patients with the newer pacing modalities, such as biventricular, His-bundle, or left bundle branch pacing.

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Correspondence to Stephen W. Smith or Yochai Birnbaum.

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The authors of this manuscript declare that there is no conflict of interest for this manuscript. These authors include Muzamil Khawaja, Janki Thakker, Riyad Kherallah, Yumei Ye, Stephen W. Smith, and Yochai Birnbaum.

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Khawaja, M., Thakker, J., Kherallah, R. et al. Diagnosis of Occlusion Myocardial Infarction in Patients with Left Bundle Branch Block and Paced Rhythms. Curr Cardiol Rep 23, 187 (2021). https://doi.org/10.1007/s11886-021-01613-0

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