Abstract 125: Exercise-Induced Prominent Anterior QRS Force Is a Reliable Sign of Left Anterior Descending Coronary Artery Disease
Prominent anterior QRS force (PAF), defined as tall R waves in the right or middle precordial leads, can be the expression of left septal fascicular block. Some cases of intermittent PAF during acute ischemia involving the septum have been published. We report a single center series of patients with transient, exercise induced PAF. In 6000 treadmill exercises tests, we found 6 patients (5 males, 1 female, mean age 63.5 y, range 56-86 y) that developed PAF during a diagnostic exercise test. The 6 patients reported angina during the test. A mean workload of 7 METS was attained (range 4,4-11). In 2 cases, there was slight anterior ST elevation, in one case there was diagnostic ST depression, and in the remaining 3 cases there were not ST changes during the exercise. All patients underwent coronariography, and a single lesion in the left anterior descending coronary artery was found ( mean severity 88,2 %, range 80-100, located proximally in 3 cases). Stenting was successfully performed in all patients. After the revascularization procedure a control exercise test showed no abnormalities. In conclusion, exercise induced PAF is infrequent (0.1 % of exercise tests), and is a reliable electrocardiographic marker of LAD disease.
- © 2011 by American Heart Association, Inc.