RIGHT POSTERIOR VENTRICULAR NECROSIS - EXPERIMENTAL-STUDY

Fifty mongrel dogs with chemical necrosis produced by infiltration of 80% phenol solution within the posterior right ventricular wall and interventricular septum were studied by ECG. Epicardial, intracavitary and anterior thoracic unipolar leads (V6R to V6) were recorded before and at least 90′ after chemical necrosis. The usual peripheral leads were also obtained. Three unipolar abdominal leads named MR, ME and ML were also registered. MR and ML were positioned at the intersection of the midclavicular and the right or left costal borders, respectively, and ME at the same horizontal level with the intersection at the midsternal vertical line. QS, QR, W or rS were obtained after necrosis instead of RS, Rs or R patterns of the control conditions. These alterations signify high right intraventricular potential variations transmitted through the necrotic wall to the epicardial surface, which in turn are reflected through the surrounding media to right (V6R to V4R) thoracic and MR leads. Right ventricular ischemia and necrosis are also registered in the bipolar II, III and augmented unipolar a VF leads, creating a problem in the differential diagnosis between classical posterior myocardial (PMI) infarction, PMI with extension to the posterior right ventricle and isolated infarction of the R.V., in as much as the latter can give rise to taller R waves in V1-V3 leads. The only ECG clue to P.R.V. location is the presence of the above mentioned epicardial morphologies in V3R, V4R and MR leads, while in posterior left ventricle necrosis, ML is most commonly altered. It is proposed to take V4R and abdominal leads routinely in order to elucidate this problem. © 1978 Research in Electrocardiology, Inc.