Value of a novel 16‐lead High‐Definition ECG machine to detect conduction abnormalities in structural heart disease

• Published in: Pacing and clinical electrophysiology 2018-06, Vol.41 (6), p.643-655
• Main Authors: Li, Guo‐Liang, Saguner, Ardan M., Akdis, Deniz, Fontaine, Guy Hugues
• Format: Article
• Language: English
• Subjects: Adult; arrhythmic right ventricular dysplasia; Arrhythmogenic Right Ventricular Dysplasia - diagnosis; Arrhythmogenic Right Ventricular Dysplasia - physiopathology; Cardiac Conduction System Disease - diagnosis; Cardiac Conduction System Disease - physiopathology; Cardiovascular disease; Conduction; Coronary artery; Coronary artery disease; Coronary Disease - physiopathology; Depolarization; ECG; EKG; Electrocardiography; Electrocardiography - instrumentation; Epsilon waves; Exercise Test; Female; Fontaine Lead System; Heart Conduction System - physiopathology; Heart diseases; Humans; Male; Middle Aged; Right ventricular dysplasia; Ventricle; Ventricular dysplasia
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.13338

Background Depolarization abnormalities are hardly detectable by standard 12‐lead electrocardiogram (ECG) in some patients. Objective To evaluate the value of the 16‐lead High‐Definition (HD)‐ECG machine to record conduction abnormalities including Epsilon waves in patients with structural heart disease. Methods Tracings with 12‐lead ECG, 16‐lead HD‐ECG, and signal‐averaged ECG were studied. Results (1) Case of severe coronary artery disease (CAD): On 16‐lead HD‐ECG, a tiny intra‐QRS signal was noted in lead III, a prolonged P wave in lead II, and fragmentation on top of lead aVL and lead aVF. Proper automatic measurement of the prolonged P wave measuring 190 ms was noted. Signal‐averaging by 16‐lead HD‐ECG in lead III showed the intra‐QRS fragmentation and P wave prolongation of 180 ms. (2) First patient with arrhythmogenic right ventricular dysplasia (ARVD): Standard 12‐lead ECG indicated Epsilon waves in lead III, V2, V3, and inverted T waves in V1–V3. 16‐lead HD‐ECG indicated QRS prolongation in lead II, III, aVL, aVF, V2, V3 as opposed to V6, and low amplitudes of QRS complexes in V4R and V3R as a new possible sign of ARVD. Notches in lead V2, widening of QRS complexes in all precordial leads, but shorter QRS in V8‐V9 are also considered as a potential new diagnostic sign of ARVD. (3) Second ARVD patient: Notches at the end of the QRS in lead III and a negative initial deflection of the QRS in V1 and V2 were detected by standard 12‐lead ECG. On 16‐lead HD‐ECG, a more pronounced QRS fragmentation was visible. Conclusion 16‐lead HD‐ECG in both CAD and ARVD seems to be more sensitive than 12‐lead ECG to record electrocardiographic abnormalities.