1 From the Department of Medicine of the University of Miami School of Medicine and the Veterans Administration Hospital; and the Division of Electrophysiology, Jackson Memorial Hospital, Miami, Florida.
Selective coronary arteriography produces characteristic ST-T changes associated with significant axis shifts. In patients with normal control ÂQRS (mean, +88.6°; sd ± 12.2°) left coronary injections induced an important leftward deviation of the ÂQRS: mean, +8.2°; sd, ±49.1° (P < 0.001). Right coronary artery opacification changed the ÂQRS from a control mean of +66.5°; sd, ±17.2° to a mean of 89.3°; sd, ±16.7° (P < 0.001). Left axis shifts after left coronary artery injections were significantly more marked than right axis deviation after right coronary injections. Important increases (beyond 0.02 sec) in ventricular activation time were not observed. These electrocardiographic abnormalities were attributed to the transient ischemic or toxic effect produced by the bolus of dye. This could result in different degrees of complete or incomplete block in the divisions of the left branch or in an extensive peripheral block affecting large areas of the subendocardial regions of the heart.
Submitted on August 8, 1969
© 1970 American Heart Association, Inc.
The Genesis of QRS Changes Produced by Selective Coronary Arteriography
Key Words: Block in the superior division of the left branch • Block in the inferior division of the left branch • Incomplete divisional blocks
Accepted on October 9, 1969
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