Electrocardiographic ST-Segment Monitoring During Controlled Occlusion Of Coronary Arteries

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Andreas Haeberlin, MD, Evelyn Studer, BM, Thomas Niederhauser, MS, Michael Stoller, MD, Thanks Marisa, MS, Josef Goette, PhD, Marcel Jacomet, PhD, Tobias Traupe, MD, Christian Seiler, MD, Rolf Vogel, MD, PhD
Journal of Electrocardiology Volume 47, Issue 1, January–February 2014, Pages 29–37


Ischemia monitoring cannot always be performed by 12-lead ECG. Hence, the individual performance of the ECG leads is crucial. No experimental data on the ECG’s specificity for transient ischemia exist.

In 45 patients a 19-lead ECG was registered during a 1-minute balloon occlusion of a coronary artery (left anterior descending artery [LAD], right coronary artery [RCA] or left circumflex artery [LCX]). ST-segment shifts and sensitivity/specificity of the leads were measured.

During LAD occlusion, V3 showed maximal ST-segment elevation (0.26 mV [IQR 0.16–0.33 mV], p = 0.001) and sensitivity/specificity (88% and 80%). During RCA occlusion, III showed maximal ST-elevation (0.2 mV [IQR 0.09–0.26 mV], p = 0.004), aVF had the best sensitivity/specificity (85% and 68%). During LCX occlusion, V6 showed maximal ST-segment elevation (0.04 mV [IQR 0.02–0.14 mV], p = 0.005), and sensitivity/specificity was (31%/92%) but could be improved (63%/72%) using an optimized cut-off for ischemia.

V3, aVF and V6 show the best performance to detect transient ischemia.