Implications of an early reversal pattern of body surface potential maps in coronary artery disease

During early ventricular depolarization, the normal body surface potential map (BSPM) has a maximal potential that is greater than the absolute value of the minimal potential; this reverses in late depolarization, so that the absolute value of the minimal potential is greater. Nevertheless, an abnormal 'early reversal' BSPM pattern has been observed in some patients with cardiovascular disease. To investigate the implications of this abnormal pattern, BSPMs were studied in 100 patients with angiographically proven coronary artery disease (CAD). There were 57 patients (57%; group A) with an abnormal early reversal pattern and 43 (43%; group B) without this early reversal pattern. A significant (> 70% narrowing) CAD lesion was observed in a significantly higher proportion of group A (97%) than group B (77%) patients, although the number of involved coronary arteries was not significantly different between the two groups. The maximal extent of the abnormal negative potential was significantly greater in group A (21.2 ± 9.6 cm2) than in group B (12.2 ± 7.5 cm2). The abnormal negative potential lasted significantly longer in group A (22.1 ± 12.1 msec) than in group B (14.4 ± 9.2 msec). Similarly, the minimal potential lasted significantly longer in group A (20.1 ± 11.3 msec) than in group B (11.8 ± 7.1 msec). These findings suggest that the abnormal early reversal BSPM pattern is a valuable indicator of extensive myocardial lesions and the severity of CAD.