STEMI with a Paced Rhythm ECG

ECG Findings:

1. Normal Sinus Rhythm

2. Ventricular Pacing

3. ST elevation suspicious for myocardial injury

Technically, the diagnosis of an anterior myocardial infarction on an ECG has never been validated in the setting of a paced rhythm, however that was the case in this ECG. There was acute occlusion of the proximal left anterior descending coronary artery. Note that the ST segments in V4 and V5 are dramatically elevated in a shape different than a normal paced QRS morphology (which is in a left bundle branch block pattern). This meets Sgarbossa criteria, however again this has not been validated in a paced rhythm (see left bundle branch block review for more details).