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      False-Negative and False-Positive ECG Diagnoses of Q Wave Myocardial Infarction in the Presence of Right Bundle-Branch Block


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          Right bundle-branch block (RBBB) has not traditionally been seen as an obstacle to ECG diagnosis of Q wave myocardial infarction (MI) – in clinical electrocardiography and vectorcardiography – because this conduction disturbance is not believed to cause significant alterations in the spatial orientation of initial excitation wavefronts. In the era of large-scale clinical trials, however, where serial ECG analysis is among the major diagnostic tools in MI classification, both false-positive and false-negative diagnoses of MI in the presence of RBBB have become increasingly evident. Because of the limited detectability of Q wave MI by ECG in the presence of RBBB, the electrocardiographic finding of Q wave MI should not be regarded as an independent diagnostic tool. It is best to utilize independent corroboration to establish the diagnosis of transmural infarction when RBBB is present. Further investigations are warranted to better delineate sensitivity, specificity, and predictive value of Q wave MI in the presence of RBBB.

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          Author and article information

          S. Karger AG
          February 2001
          02 March 2001
          : 94
          : 3
          : 165-172
          aMayo Physician Alliance for Clinical Trials, Rochester, Minn., bDivision of Cardiology, St. Louis University Health Science Center, St. Louis, Mo., cCardiology Products Division, Hewlett-Packard, Andover, Mass., and dDivision of Cardiovascular Diseases and Internal Medicine, Rochester, Minn., USA
          47312 Cardiology 2000;94:165–172
          © 2001 S. Karger AG, Basel

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          Page count
          Figures: 6, References: 36, Pages: 8
          Arrhythmias, Electrophysiology and Electrocardiography


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