Key result
BiV pacing allows accurate ECG identification of inferior STEMI via physiologic electrical activation.
Why the study?
Diagnosing acute STEMI in patients with ventricular pacing is difficult because abnormal activation patterns can mask ischemic changes on ECG.
Case Report (n=1)
Biventricular pacing preserves a more physiologic ventricular activation pattern compared to traditional right ventricular pacing, allowing for accurate ECG detection of acute STEMI.
May aid ECG STEMI diagnosis in biventricularly paced patients; hypothesis-generating and should not change practice.
Diagnosing acute ST-elevation myocardial infarction (STEMI) in patients with ventricular pacing is difficult due to abnormal activation patterns that can mask ischemic changes on ECG. Unlike traditional right ventricular pacing, biventricular (BiV) pacing produces a better physiologic depolarization, improving detection. A 69-year-old male with heart failure with reduced ejection fraction and a BiV pacemaker presented with acute chest pain. ECG revealed inferior STEMI, and successful treatment was done for a critically stenotic proximal right coronary artery. BiV pacing provides a more synchronous and physiologic ventricular activation pattern compared to other modalities that disrupt normal depolarization and hinder ECG interpretation with acute ischemia. Within this case, the physiologic electrical activation produced by BiV pacing allowed for accurate ECG identification of STEMI and improved mechanical synchrony. BiV pacing can enhance ECG detection of acute STEMI compared to traditional pacing, aiding prompt diagnosis and intervention in patients with heart failure.
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Govil et al. (2025) conducted a case report in Acute ST-elevation myocardial infarction (STEMI) (n=1). Biventricular (BiV) pacing vs. Right ventricular (RV) pacing (historical/theoretical) was evaluated on Accurate ECG identification of STEMI. Biventricular pacing allowed for accurate ECG identification of an inferior STEMI due to its physiologic electrical activation pattern, leading to successful percutaneous coronary intervention.
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