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Body Surface Electrocardiographic Mapping in Inferior Myocardial Infarction: Manifestation of Left and Right Ventricular Involvement

To determine the depolarization and repolarization time-integral patterns in patients with first acute inferior myocardial infarction, we acquired body surface potential maps in 28 men and eight women, ages 36–76 years, a mean of 76 hours after the onset of symptoms. Based on technetium-99m pyrophosphate myocardial scans, patients were divided into two groups. Group 1 included 22 patients with scintigraphic activity limited to the left ventricle who were considered to have exclusive left ventricular infarction, and group 2 included 14 patients with scintigraphic activity involving the right ventricle in addition to the left ventricle, considered to have both left and right ventricular infarction.Isointegral plots of the first 50% of the QRS complex (Q zone) were characterized by negative areas over the inferior torso with concomitant extension of positive areas to the superior precordium. Group 2 patients had greater leftward and superior extension of the negative inferior distributions than group 1 patients. Subtraction of the mean Q-zone map of group 1 patients from that of group 2 patients confirmed a mean area of difference over the right anterior-inferior torso. The average Q-zone integral value within this area of difference was 5.9 + 7.2, uVsec (±+ SD) for group 1 patients compared with 1.7 + 5.2, V-sec for group 2 patients (p < 0.05). ST-segment isointegral maps revealed positive inferior distributions in all subjects; however, 29 patients also had abnormal negative ST-segment distributions over the precordium. The area of negative precordial values in group 2 patients extended further rightward and inferiorly compared with group 1 patients. There were two large areas of difference seen on subtraction: one over the precordium, in which the mean ST-segment integral value for group 1 patients was -0.6 + 3.8 AV-sec, compared with –3.2 3.2 tkVNsec for group 2 patients (p < 0.025), and another over the inferior torso, where the mean value for group 1 was 1.2 ± 1.6, uV-sec, compared with 3.3 ± 3.5, xV sec for group 2 (p < 0.05).Thus, in acute inferior infarction, there is a characteristic distribution of negative Q-zone and positive ST-segment time integrals over the inferior torso and a reciprocal development of positive Q-zone and negative ST-segment integrals over the anterior-superior torso. Patients with right ventricular involvement, however, have spatial and quantitative abnormalities of both depolarization and repolarization that distinguish them from patients with infarction limited to the left ventricle.