Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov 17;23(12):187.
doi: 10.1007/s11886-021-01613-0.

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

Muzamil Khawaja  1 , Janki Thakker  1 , Riyad Kherallah  1 , Yumei Ye  2 , Stephen W Smith  3 , Yochai Birnbaum  4
Affiliations
Review

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

Muzamil Khawaja et al. Curr Cardiol Rep. .

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. 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.

Keywords: Left bundle branch block; Occlusion myocardial infarction; Right ventricular pacing; ST-elevation myocardial infarction; Sgarbossa criteria; Smith-modified Sgarbossa criteria.

PubMed Disclaimer

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
    1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction. Circulation. 2018; 138(20):e618-e651. https://doi.org/10.1161/CIR.0000000000000617 . - DOI - PubMed
    1. Aslanger EK, Yildirimturk O, Simsek B, Bozbeyoglu E, Simsek MA, Yucel Karabay C, et al. DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study). Int J Cardiol Heart Vasc. 2020;30(30): 100603. https://doi.org/10.1016/j.ijcha.2020.100603 . - DOI - PubMed - PMC
    1. Pendell Meyers H, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Int J Cardiol Heart Vasc. 2021;33:100767. https://doi.org/10.1016/j.ijcha.2021.100767 .
    1. Brady WJ, Aufderheide TP. Left bundle branch block pattern complicating the electrocardiographic evaluation of acute myocardial infarction. Acad Emerg Med. 1997;4(1):56–62. https://doi.org/10.1111/j.1553-2712.1997.tb03644.x . - DOI - PubMed
    1. •Pera VK, Larson DM, Sharkey SW, Garberich RF, Solie CJ, Wang YL, et al. New or presumed new left bundle branch block in patients with suspected ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care. 2018;7(3): 208–217. https://doi.org/10.1177/2048872617691508 . This study found that patients presenting with new LBBB and ischemic symptoms had fewer coronary culprit artery lesions than patients without new LBBB and higher all-cause mortality. Moreover, these patients were older, more commonly women, had a lower ejection fraction, and more often presented with cardiac arrest or heart failure than those without new LBBB.

LinkOut - more resources