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33rd International Congress on Electrocardiology

International Society of Electrocardiology

An additional lead aVL-Neb in patients with acute myocardial infarction and acute coronary syndrome - the using technology and clinical significance

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33rd International Congress on Electrocardiology. Cologne, 28.06.-01.07.2006. Düsseldorf, Köln: German Medical Science; 2007. Doc06ice091

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Published: February 8, 2007

© 2007 Serafinovich.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Direct signs of posterior myocardial infarction (MI) in 12-lead ECG are not revealed. Reciprocal changes are not severely specific and can be interpreted differently. The aim of this study is to present the new ECG lead aVL-Neb (A.c. 1785654, A61B5/04), using for diagnosis of posterior wall ischemic lesion.

Materials and methods: Patients with proved myocardial infarction (MI) (n=143) in various heart regions and types and 36 healthy persons in control group were included in the study. In patients the 12-lead ECG and additional leads V7-V9, ECG mapping by 60 unipolar Wilson leads and ECG in Neb-system including aVL-Neb lead have been made and compared at admission, at 2nd, 3rd, 6th, 12th and 20th days from the onset. The technology of use the aVL-Neb lead: ECG record is performed by placing electrodes in Neb system with aVL switch being turned on. The action algorithm: 1st stage – to reveal signs of reduced perfusion in posterior wall of LV in 12-lead ECG and/or clinically; 2nd stage – to record and analyze changes in aVL-Neb. The posterior wall lesion leads to ST elevation in aVL-Neb, to forming abnormal Q wave, to de-creasing or absence of R wave (Q/R>1/3) and for inverted T wave.

Comparison of diagnostic possibilities of aVL-Neb to Dorsalis and V7 has been made. The study has revealed material advantages of this method: the sensitivity was 82%, 46%, 33% accordingly, with high specificity. Besides aVL-Neb lead is not inferior to ECG mapping on posterior chest wall. At present we are studying the ECG changes in aVL-Neb in dependence from coronary artery oc-clusion site and result of invasive treatment and myocardium perfusion.

Conclusion: The ECG by aVL-Neb lead allows revealing features of reduced perfusion in posterior wall of LV in early stages of MI, differentiating in acute coronary syndrome, moving some patients with acute coronary syndrome without ST elevation into group with ST elevation, revealing the ischemia in patients with angina.