Vectorcardiographic monitoring of patients with acute myocardial infarction and chronic bundle branch block

AIMS: This study was set up to describe vectorcardiographic patterns in patients with bundle-branch block and acute myocardial infarction. METHODS AND RESULTS: Sixty-five patients admitted to the coronary care unit with bundle-branch block and suspected acute myocardial infarction were monitored by dynamic vectorcardiography with trend analysis. In 28 patients, a clinical diagnosis of acute myocardial infarction was made. In patients with left bundle-branch block and acute myocardial infarction, the pattern of QRS vector-difference evolution was similar to that in patients with the narrow QRS complex, while ST vector-magnitude changes increased over time. Using a cut-off value for QRS vector-difference at 12 h of more than 20 microVs and a specific trend curve pattern, acute myocardial infarction in the presence of left bundle-branch block could be diagnosed with an accuracy of 71%. For patients with right bundle branch block, using a maximum ST vector-magnitude of > 200 microV during the first 4 h, acute myocardial infarction could be diagnosed with a 78% accuracy. CONCLUSION: Our results indicate that dynamic vectorcardiography is a valuable tool in diagnosing and monitoring acute myocardial infarction in patients with bundle branch block.