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

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. KeywordsOcclusion myocardial infarction • Sgarbossa criteria • Smith-modified Sgarbossa criteria • Right ventricular pacing • ST-elevation myocardial infarction • Left bundle branch block This article is part of the Topical Collection on Management of Acute Coronary Syndromes

Especificidade e Sensibilidade Dos Critérios de Sgarbossa e Barcelona no Diagnóstico de Infarto Agudo do Miocárdio na Vigência de Bloqueio de Ramo Esquerdo

“…No entanto, não há estudos suficientes que abordam a diferença de sensibilidade dos critérios quanto ao sexo masculino e feminino separadamente. (RANGANATHAN et al, 2023;KHAWAJA et al, 2021;MACFARLANE et al, 2020;DI MARCO et al, 2020. ) O critério de Sgarbossa se demonstrou altamente específico para diagnosticar infarto agudo do miocárdio em pacientes com bloqueio de ramo esquerdo, quando uma pontuação de 3 pontos é alcançada (CAI et al, 2013).…”