The de Winter electrocardiographic pattern: A systematic review of case reports

Abstract

Background: It has been established that concurrent ST-T alterations in limb leads can assist in identifying the location of left anterior descending (LAD) artery occlusion. The de Winter pattern is an atypical electrocardiographic manifestation characterized by ST-segment depression associated with LAD artery occlusion. We hypothesized that this atypical pattern could potentially interfere with the accurate localization of the LAD occlusion site on the electrocardiogram. We aimed to describe the distinctive characteristics of the de Winter pattern and to compare electrocardiographic variables in proximal and distal occlusions of the LAD artery.

Methods: A systematic review was conducted using the PRISMA guidelines. PubMed, Scopus, and Web of Science were searched from their inception to June 2024. Continuous variables were compared using the Kruskal-Wallis test.

Results: Sixty-six cases with LAD related lesions were included. The majority of cases involved young males with a low proportion of prior coronary artery disease. Most patients had sinus rhythm and normal QRS duration. ST-T changes in limb leads were common in the patients studied (91%), but our analysis showed that differentiating between proximal and distal occlusions based on these changes was challenging.

Conclusion: The de Winter pattern is primarily observed in young males with a low proportion of prior coronary artery disease. While ST-T changes in limb leads are frequent, localizing the LAD occlusion site based on these changes can be difficult. Further research is needed to understand the underlying mechanisms, prevalence, and improve diagnostic accuracy for this atypical pattern.

Keywords: Coronary occlusion; Electrocardiography; Non-ST elevated myocardial infarction; de Winter pattern.