[Present and future of cardiac function tests: electrophysiologic tests].

Area of Science:

• Cardiology and Electrophysiology
• Diagnostic Technologies in Cardiovascular Medicine

Context:

• The evolution of electrocardiogram (ECG) systems, initiated by Einthoven's 12-lead system, spans nearly a century.
• Current research explores novel cardiac repolarization parameters, including transmural dispersion of repolarization, T wave alternans, and QT dispersion, to assess ventricular repolarization.
• Established methods like Holter ECG for heart rate variability and head-up tilt tests for autonomic function remain crucial diagnostic tools.

Purpose:

• To review the development and clinical utility of various electrocardiographic and physiological tests.
• To highlight emerging parameters for assessing cardiac ventricular repolarization and autonomic function.
• To discuss advancements in electrophysiological studies (EPS) and catheter ablation technologies, including electroanatomical mapping systems.

Summary:

• QT dispersion, while proposed to reflect regional ventricular repolarization, faces challenges in clinical acceptance due to unresolved issues.
• Heart rate variability from Holter ECG and head-up tilt tests are valuable for assessing autonomic tone and diagnosing syncope.
• Innovations like the CARTO system for three-dimensional electroanatomical mapping are transforming catheter ablation procedures.
• Transtelephonic ECG with computer-assisted analysis offers a practical approach for diagnosing and managing paroxysmal cardiac symptoms.

Impact:

• These evolving diagnostic and therapeutic tools aim to improve the management of complex cardiac conditions.
• Advancements in electrophysiology and mapping systems are enhancing the precision and efficacy of interventional cardiac procedures.
• Improved diagnostic capabilities can lead to earlier detection and more effective treatment strategies for patients with cardiac arrhythmias and syncope.