Low Level and High Frequency Fragmentation of the QRS Changes during Acute Myocardial Ischemia in Patients with and without Prior Myocardial Infarction

High frequency (HF) QRS fragmentation and very-low amplitude abnormal intra-QRS potential (uAIQP) analyses have been used to track ischemic changes during coronary artery occlusions. The aim of this study was to assess the relationship between these two techniques in detecting acute myocardial ischemia and the effects of a previous myocardial infarction (MI). Fifty-six patients who underwent elective percutaneous coronary intervention (PCI) procedures were selected and classified into 2 groups according to the presence of prior healed MI (old-MI) (n=18) or not (no_MI) (n=38). Continuous ECG before and during the PCI were recorded and signal-averaged. uAIQPs were obtained using a signal modelling approach. HFQRSRMS was obtained by band pass filtering the ECGs at 150 to 250 Hz. QRS-HFpower was estimated from a modelling power spectral technique. uAIQP and HF indices were obtained from a baseline and an occlusion-PCI ECG episode. uAIQP and HF values decreased (p<0.05) for each of the 12 leads at the PCI event respect to baseline in all patients and the no-MI group. Changes in uAIQP or HF did not separate the groups. uAIQP and QRS-HFpower values at baseline were lower in all leads, except V1-V2, in the old-MI groups compared to no-MI (p<0.05). Pearson’s correlation showed moderate relationship among the indices in most of leads. High-frequency QRS fragmentation indices could add diagnostic value to ST analysis for diagnosing ischemia when a baseline ECG information is available. Patients with old-MI presented lower uAIQP amplitudes compared to no-MI, however further studies are needed to elucidate the effects of old MI on very-low level fragmentation of the QRS. 1.