Titre du document / Document title

Analyse funktioneller Veränderungen ventrikulärer Spätpotentiale zur Risikoabschätzung von Kammertachykardien nach Herzinfarkt = Functional late potential analysis for risk stratification in patients after myocardial infarction prone to ventricular tachycardia

Auteur(s) / Author(s)

STEINBIGLER P. ⁽¹⁾ ; HABERL R. ⁽¹⁾ ; JILGE G. ⁽¹⁾ ; KNEZ A. ⁽¹⁾ ; DORWARTH U. ⁽¹⁾ ; MÜLLER D. ⁽¹⁾ ; HOFFMANN E. ⁽¹⁾ ; STEINBECK G. ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Medizinische Klinik I der Universität München, Marchioninistr. 15, 81366 München, ALLEMAGNE

Résumé / Abstract

Background. Electrophysiological abnormalities during ischaemia and increased heart rate may influence the detection of ventricular late potentials in the surface electrocardiogram. Whether the analysis of functional changes adds information to the risk stratification of patients prone to ventricular tachycardia is unclear. Methods. We therefore retrospectively investigated 100 selected patients (25 with documented, sustained ventricular tachycardia (< 230/min) (= VT group), 25 resuscitated from ventricular fibrillation (VF group) and 50 without ventricular arrhythmias (Ø VT/VF group)) in the chronic phase after myocardial infarction. Late potential analysis was performed at rest, during atrial pacing at a rate of 100/min and 120/min (n = 60), during and after occlusion of the coronary artery for coronary angioplasty (PTCA) (n = 70), and immediately after maximum exercise using selective signal averaging. Results. At rest in 72 % of patients in the VT group, in 32 % of the VF group, and in 6% of the Ø VT/VF group late potentials could be found. During atrial pacing in 80 % of patients in the VT group, in 72 % of the VF group, and in 10% of the patients in the Ø VT/VF group and during ischaemia because of occluded coronary artery in 86 % of patients in the VT group, 70% of the VF group, and in 20 % of the patients of the Ø VT/VF group late potentials were present. Immediately after maximum exercise which let to both ischaemia and increased heart rate, late potentials were detectable in 92 % of patients in the VT group, 80 % of the VF group, and in 14% of patients in the Ø VT/VF group. Similar results could be achieved by using the Holter-ECG after exact correction of recorder tape speed variations. 62 % of patients with only by ischaemia, increased heart rate or exercise provokable late potentials and all patients with preexistent not by PTCA extinguished late potentials developed recurrent ventricular tachycardias during the one year follow-up period. Patients without late potentials (n = 50) and patients with preexistent by PTCA extinguished late potentials (n = 11) had no recurrent ventricular tachycardias. Cycle length of recurrent and clinical tachycardia in patients with preexistent not by PTCA extinguished late potentials (n = 18) were significantly longer than in patients with only provokable late potentials (n = 21). Conclusions. Analysis of functional changes of ventricular late potentials with exercise or in Holter ECG recordings promises considerable improvement of postinfarction risk stratification especially in patients prone to ventricular fibrillation.

Revue / Journal Title

Zeitschrift für Kardiologie   ISSN 0300-5860   CODEN ZKRDAX 

Source / Source

1998, vol. 87, n^o6, pp. 459-470 (45 ref.)

Langue / Language

Allemand
Revue : Anglais

Editeur / Publisher

Steinkopff, Darmstadt, ALLEMAGNE  (1973-2005) (Revue)

Mots-clés anglais / English Keywords

Infarct ; Myocardium ; Paroxysmal ventricular tachycardia ; Electrocardiography ; Signal processing ; Amplification ; Retarded potential ; Prognosis ; Complication ; Human ; Cardiovascular disease ; Coronary heart disease ; Myocardial disease ; Heart disease ; Arrhythmia ; Excitability disorder ; Electrodiagnosis ;

Mots-clés français / French Keywords

Infarctus ; Myocarde ; Tachycardie paroxystique ventriculaire ; Electrocardiographie ; Traitement signal ; Amplification ; Potentiel retardé ; Pronostic ; Complication ; Homme ; Appareil circulatoire pathologie ; Cardiopathie coronaire ; Myocarde pathologie ; Cardiopathie ; Trouble rythme cardiaque ; Trouble excitabilité ; Electrodiagnostic ;

Mots-clés espagnols / Spanish Keywords

Infarto ; Miocardio ; Taquicardia paroxística ventricular ; Electrocardiografía ; Procesamiento señal ; Amplificación ; Potencial retardado ; Pronóstico ; Complicación ; Hombre ; Aparato circulatorio patología ; Cardiopatía coronaria ; Miocardio patología ; Cardiopatía ; Arritmia ; Trastorno excitabilidad ; Electrodiagnóstico ;

Localisation / Location

INIST-CNRS, Cote INIST : 8594, 35400007227821.0050