A case of acute myocardial infarction in paced rhythm. Utility of the Barcelona algorithm.

We describe the case of a 70-year-old man with a pacemaker implant who presented to us with atypical chest pain. His admission ECG did not satisfy the criteria for myocardial infarction according to standard Sgarbossa criteria, and Smith modified Sgarbossa criteria. However, we applied the recently developed Barcelona algorithm, which is used to diagnose acute myocardial infarction in the presence of intrinsic left bundle branch block.Electrocardiographic criteria for an acute myocardial infarction were met. Lead V6 displayed a low voltage QRS complex (3 mm) with 1 mm ST depression, satisfying the Barcelona criteria for acute myocardial infarction. He underwent primary angioplasty for critical in-stent restenosis of the left anterior descending coronary artery. This is the first case report, to the best of our knowledge, where Barcelona algorithm has been used to diagnose acute coronary syndrome in right-ventricular paced rhythm.