Absence of ST-Segment Elevation in Inferior and Lateral Leads in Patients With Complete Right Bundle Branch Block Is an Index of Underlying Cardiac Pathology

A recent report called attention to the nature of the ST-segment elevation (STSE) in some or all inferior and/or lateral electrocardiogram (ECG) leads (i.e., I, II, III, aVL, aVF, V5, and V6), which are frequently encountered in patients with stable or transient complete right bundle branch block (RBBB). These STSEs represent secondary repolarization changes due to late depolarization RBBB alterations; are stable over the course of many years in patients with RBBB; and do not reflect cardiac pathology, as the automated ECG interpretation algorithms erroneously indicate. Indeed, the absence of such STSEs in patients with RBBB suggests the presence of underlying acute or old myocardial infarc-tion, acute myocardial ischemia, or left ventricular hypertrophy and thus constitute an as yet undescribed ECG index of cardiovascular pathology. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;203:362-367)