Acute ST-Elevation Myocardial Infarction (STEMI) Diagnoses in a Biventricular-Paced ECG

Diagnosing acute ST-elevation myocardial infarction (STEMI) in patients with ventricular pacing is difficult due to abnormal activation patterns that can mask ischemic changes on ECG. Unlike traditional right ventricular pacing, biventricular (BiV) pacing produces a better physiologic depolarization, improving detection. A 69-year-old male with heart failure with reduced ejection fraction and a BiV pacemaker presented with acute chest pain. ECG revealed inferior STEMI, and successful treatment was done for a critically stenotic proximal right coronary artery. BiV pacing provides a more synchronous and physiologic ventricular activation pattern compared to other modalities that disrupt normal depolarization and hinder ECG interpretation with acute ischemia. Within this case, the physiologic electrical activation produced by BiV pacing allowed for accurate ECG identification of STEMI and improved mechanical synchrony. BiV pacing can enhance ECG detection of acute STEMI compared to traditional pacing, aiding prompt diagnosis and intervention in patients with heart failure.