Why the study?
Diagnosing ST-segment elevation myocardial infarction in the presence of left bundle branch block is challenging, and presentation with concomitant atrial fibrillation impacts morbidity and mortality.
Proposes 'Yasser's criterion'—discrepant inferior ST-segment deviations—as a new ECG sign in patients with atrial fibrillation and left bundle branch block suspected of acute myocardial infarction.
Yasser's criterion may aid MI diagnosis in LBBB with AF; leaves open need for prospective validation before adoption.
Rationale: Diagnosis of ST-segment elevation myocardial infarction in the presence of left bundle branch block (LBBB) is a challengeable and infarction equivalent. Therefore, the intravenous infusion of thrombolytic may be a crucial step. Emergent Sgarbosa criteria and their modification are guided advantageous guide keys. Atrial fibrillation represents the risk of arrhythmia in the presence of a left bundle branch block. Interestingly, the presentation of myocardial infarction with atrial fibrillation and left bundle branch block has a risk impact on both morbidity and mortality of patients. Patient Concerns: A middle-aged married Painter heavy smoker Egyptian male patient was admitted to the intensive care unit with acute chest pain with rapid atrial fibrillation and left bundle branch block. Diagnosis: Left bundle branch block with atrial fibrillation and inferior Yasser’s criterion (Discrepancy criteria) ST-segment deviations as a new description in suspected acute myocardial infarction. Interventions: Electrocardiography, oxygenation, streptokinase IV infusion, and echocardiography. Outcomes: Gradual dramatic clinical and electrocardiographic improvement but still atrial fibrillation and left bundle branch block had happened. Lessons: Yasser’s criterion (Discrepancy criterion) is a new descriptive criterion for atrial fibrillation with aberrancy (atrial fibrillation and left bundle branch block). It is characterized by discrepant inferior ST-segment deviations with ST-elevation in III and aVR leads with ST-depression in II and aVF leads. It is an unknown mechanism. Both inferior infarctions of a single lead and pulmonary embolization are possible associations. It may be interpreted as accompanied by severe specific ischemic myocardial insult. Future wide-research studies for Yasser’s criterion (Discrepancy criterion) for sensitivity and specificity will be recommended.
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