THE INVERSE NEHB-J LEAD INCREASES THE SENSITIVITY OF HOLTER ELECTROCARDIOGRAPHIC MONITORING FOR DETECTING MYOCARDIAL-ISCHEMIA

A major reason for the relatively low sensitivity of Holter electrocar diography (EGG) for detecting ischemia is that the sensitivity of bipo lar leads used for Holter ischemia monitoring has not been systematica lly evaluated, making lead selection difficult. Therefore, this study evaluated the sensitivity of 6 bipolar Holter leads for detecting isch emia during percutaneous transluminal coronary angioplasty. Seventy-fi ve patients, each of whom had >1 mm ST-segment elevation on an intraco ronary electrocardiogram from the myocardium distal to the stenosis du ring balloon occlusion, were studied for the occurrence of greater tha n or equal to 1 mm ST-segment elevation or depression on the simultane ously recorded Holter leeds II, III, aVF, CM5, CR4, and inverse Nehb J . The study found that the inverse lead Nehb J provided a significantl y higher overall sensitivity for detecting myocardial ischemia than Ho lter leeds II, III, aVF, CM5, and CR4. Also, the use of inverse lead N ehb J significantly increased the sensitivity of 2- and 3-lead Holter ischemia monitoring. These findings were based on a significantly high er sensitivity of inverse lead Nehb J for detecting ischemia induced b y transient occlusion of the left anterior descending coronary artery and a slightly higher sensitivity for detecting ischemia induced by oc clusion of the left circum; flex coronary artery. None of the bipolar leads studied provided a very high sensitivity for detecting ischemia induced by occlusion of the right. coronary artery. These findings sho w that adequate lead selection can increase the sensitivity of Halter ischemia monitoring. Furthermore, the lack of a highly sensitive lead for detection of inferior ischemia indicates that further evaluation o f bipolar leads is warranted. (C) 1997 by Excerpta Medico, Inc.