Anyone who has learned to read ECGs has heard it before: "You can't diagnose acute myocardial infarction (AMI) on an ECG in the presence of a pacemaker." We have actually heard the same dictum regarding the diagnosis of AMI on ECG in patients with left bundle branch block (LBBB).
In 1996, Sgarbossa and colleagues published a set of ECG findings that could be used to diagnose AMI in the presence of LBBB with high specificity. These Sgarbossa criteria were later refined and validated as the modified Sgarbossa criteria, which have been widely discussed and accepted by many as a reliable means of diagnosing acute coronary occlusion in the presence of LBBB. Criteria for diagnosing acute coronary occlusion in the presence of a ventricular pacemaker were also suggested by Sgarbossa and colleagues in 1996, but these criteria had a tougher time gaining acceptance because the original study population was so small and high-quality validation studies were lacking.
However, Dodd and colleagues have recently published a high-quality trialthat validated the use of the modified Sgarbossa criteria for diagnosing acute coronary occlusion in the presence of a ventricular paced rhythm. They performed a retrospective case-control study involving 16 cardiac referral centers in the United States and four other countries and included adult patients with ventricular paced rhythms presenting with symptoms of
