Ventricular injury in acute left circumflex occlusion: Exploration using precordial bipolar leads and regional VECTORCARDIOGRAMS

We have developed a method that allows us to derive numerous bipolar and unipolar electrocardiographic leads from traditional 12‑lead “digital” ECGs, from which we can also generate regional vectorcardiograms (Regional VCGs). We are confident that this methodology will eventually become a new ECG diagnostic tool that will help substantiate and even improve diagnosis by providing valuable insights. We have previously outlined this new approach in our latest review and earlier publications. [1].

Recently, we have reported the usefulness of this methodology in patients with hyperacute myocardial ischemia due to LAD [2] and RCA [3] occlusion. In this study, we examined patients with acute CxCA occlusion.

Contrary to the typical presentation of ST segment elevation in anterior ECG leads (V1-V4) in patients afflicted with occlusion of the LAD, or in inferior (II, III, aVF) leads when the RCA is acutely occluded, acute obstruction of the CxCA leads to inconsistent, less specific ST segment displacements, ranging from elusive changes such as ST depression in lateral or inferior leads (linked to the location of the occlusion) as well as reciprocal ECG changes [4]. As a consequence, the challenging diagnosis of CxCA occlusion may ultimately leads to delays in revascularization procedures with unfavorable outcomes. Our novel method could offer significant diagnostic insights and consequential benefits for these patients.

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