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Signal-averaged electrocardiogram in patients with arrhythmogenic right ventricular cardiomyopathy and ventricular
1Departments of Cardiology, University of Padua Medical School, Padua, Italy.
Insights
The signal-averaged ECG shows a strong correlation with the extent of arrhythmogenic right ventricular cardiomyopathy but is less effective for diagnosing minor disease forms or specific arrhythmias. It is a useful non-invasive tool for monitoring disease progression.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic heart muscle disease.
- Ventricular arrhythmias are a common complication of ARVC.
Purpose of the Study:
- To evaluate the signal-averaged ECG's (SAECG) diagnostic performance in ARVC patients.
- To determine the SAECG's sensitivity, specificity, and predictive value for ARVC and various ventricular arrhythmias.
Main Methods:
- SAECG was performed on 138 ARVC patients and 146 healthy controls using a 3-bandpass filter system.
- Abnormal SAECG was defined by at least two abnormal parameters at each filter setting.
- Patients were stratified by ARVC severity (mild, moderate, extensive) and arrhythmia type.
Main Results:
- SAECG was abnormal in 57% of ARVC patients versus 4% of controls (sensitivity 57%, specificity 95%, PPV 92%).
- Abnormality correlated with ARVC extent: 94.4% in extensive, 77.7% in moderate, 31.8% in mild forms.
- Strongest correlation was with sustained ventricular tachycardia (94.4%), while other arrhythmias showed varied correlations (16.6%-55.8%).
Conclusions:
- SAECG correlates better with ARVC extent than arrhythmia presence.
- SAECG is not sensitive for minor ARVC but is a valuable non-invasive tool for assessing disease progression.
Objective:
The aim of the study was to assess the prevalence, sensitivity, specificity and predictive value of the signal-averaged ECG in patients with arrhythmogenic right ventricular cardiomyopathy and different forms of ventricular arrhythmias.
Methods:
The signal averaged ECG in 138 patients and 146 healthy subjects (control group), using a three bandpass filter system (25-250, 40-250, 80-250 Hz), was considered abnormal when at least two parameters were abnormal at each filter setting. Patients were divided into three groups according to the extent of the right ventricular enlargement (mild, moderate, extensive), and into five groups according to the type of ventricular arrhythmia.
Results:
The signal averaged ECG was abnormal in 57% of the patients and in 4% of the healthy subjects. The sensitivity was 57%, specificity 95% and positive predictive value 92%. The signal averaged ECG was abnormal in 94.4% of patients with the extensive form of the disease, in 77.7% of patients with the moderate form and in 31.8% of patients with the minor form, demonstrating good correlation with the extent of the disease. According to the type of ventricular arrhythmia, a higher correlation was found between signal averaged ECG abnormality and sustained ventricular tachycardia with superior axis (94.4%, P<0. 02); the correlation for the other arrhythmias varied from 16.6% to 55.8%.
Conclusion:
There is a closer correlation between the signal averaged ECG and extent of disease than with the presence of ventricular arrhythmias. The signal averaged ECG is not helpful in diagnosing minor forms of the disease, but since it is a non-invasive method, it may be useful in evaluating progression of the disease.
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