This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by FLOWERS, N. C. Articles by THOMAS, J. R. Search for Related Content PubMed Articles by FLOWERS, N. C. Articles by THOMAS, J. R.

(Circulation. 1969;40:927.)
© 1969 American Heart Association, Inc.

---

Localization of the Site of Myocardial Scarring in Man by High-Frequency Components

NANCY C. FLOWERS M.D.¹; LEO G. HORAN M.D.¹; W. J. TOLLESON M.D.¹; J. R. THOMAS M.D.¹

¹ From the Section of Cardiology, Medical Service, Forest Hills Veterans Administration Hospital; the Department of Medicine, Medical College of Georgia, Augusta, Georgia; the Section of Cardiology, Medical Service, Kennedy Veterans Administration Hospital; and the Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee School of Medicine, Memphis, Tennessee.

The increased incidence of high-frequency components (notching) in electrocardiographic (ECG) recordings previously has been related to coronary artery disease, primary myocardial disease, and biventricular enlargement.

This study included 130 subjects on whom autopsy permission was obtained, who had one or more sets of high-frequency, orthogonal ECG (XYZ) leads and direct-writing standard ECG leads recorded ante mortem. In each instance careful dissection of the heart was performed by two or more of the authors according to fixed protocol.

Correlations were made between the site of infarction and the occurrence of notching in specific high-frequency ECG leads. Postero-inferior infarctions tended to express themselves with a predominance of increased notching in the Y lead, while anterior infarction manifested dominantly in the X lead. This was true in intramural as well as transmural lesions.

The greatest value of notch recognition in diagnosing and localizing infarction appeared to be in subjects with normal sized hearts, with none of the classic ECG criteria for infarction, but who ultimately proved to have intramural scarring. In these subjects the increased incidence of notching clearly could not be attributed to biventricular enlargement, nor could the ECG diagnosis of infarction be arrived at by conventional criteria.

Key Words: Intramural infarction • QRS notching and slurring