Oct 1, 1989

The tall R wave in lead V1 in posterior myocardial infarction: a reciprocal sign or a His-Purkinje conduction disturbance?

Pacing and Clinical Electrophysiology : PACE
B Brembilla-PerrotC Pernot


The significance of the tall R wave in lead V1 with an R/S ratio greater than or equal to 1 in posterior myocardial infarction (PMI) was investigated in 28 patients during programmed electrical stimulation. The patients had been admitted with acute PMI documented by electrocardiogram and proven by enzymatic increase. Electrophysiological study was performed 3 weeks after acute PMI. In 17 of the 28 patients (group 1), the tall R wave in V1 disappeared during stimulation: In 13 of them a premature atrial extrastimulus was responsible for an abrupt normalization of QRS complex in V1 related to an increase in AH or HV interval. In the 4 remaining patients the disappearance of the tall R wave in V1 was related to a sinus pause. In 14 patients of group 1, a different prematurity in atrial stimulation induced a right or left bundle branch block (BBB). In 11 of the 28 patients (group 2) the tall R wave in V1 was unchanged but a premature atrial extrastimulus induced a right BBB in 5 patients and a left BBB in 6. In conclusion, the normalization of QRS complex in lead V1 during atrial stimulation or alterations in cycle length suggests that the tall R wave in V1 in PMI is not a simple reciprocal sign of leads V8 V9. Its association with...Continue Reading

Mentioned in this Paper

Bundle-Branch Block
Myocardial Infarction
Cardiac Conduction System
Electrophysiology (Science)
Cardiac Pacing, Artificial
Electrocardiographic Recorders
Anterior Fascicular Block

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