Right ventricular pacing causes secondary repolarization changes of opposing polarity to that of the predominant QRS complex. Most leads have predominant negative QRS complexes followed by ST-segment elevation and positive T waves. ST-segment elevation 35 mm was most indicative of AMI in leads with predominantly negative QRS complexes. Any ST-segment elevation concordant to the QRS complex in a predominantly positive QRS complex was highly specific for AMI. The QRS complex is predominantly negative in leads V! to V3. ST-segment depression in these leads had 80 percent specificity for AMI.9
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