On the Feasibility of Locating Myocardial Bridge though the 12-Lead Electrocardiogram: a Case Study

Myocardial bridge (MB) is a coronary artery variation where the artery tunnels through the myocardium rather than running on its surface, potentially causing ischemia and sudden cardiac death. Locating MB typically requires various imaging modalities, making widespread screening impractical. Consequently, clinical tests are usually performed after symptoms occur. We aimed to explore the feasibility of using a 12-lead electrocardiogram (ECG) to detect and locate MB by utilizing a 12-lead Holter ECG from a male patient with MB proximal to the anterior descending branch of the left coronary artery, as assessed via echocardiography. Additionally, a synthetic 12-lead ECG simulating the presence of ischemia in the same location and normal sinus rhythm, respectively, was used to feed CineECG, which processes the 12-lead ECG to generate a video where a moving vector represents the average electrical activation sequence in the heart. Visual inspection of the CineECG images indicated that, in correspondence with the ST segment, typically displaced in case of ischemia, the vector pointed towards the left anterior wall and septum rather than towards the heart apex, as observed in the normal resting ECG, suggesting that CineECG can detect ischemic-like changes associated with MB, appears to be a promising method for detecting and locating MB.