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Prevalence of late potentials on signal-averaged ECG in patients with psychiatric disorders
Christos-Konstantinos Antoniou1, Ippokratis Bournellis1, Achilleas Papadopoulos2
1First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
Insights
Psychiatric patients have a higher prevalence of late potentials (LPs) detected by signal-averaged electrocardiography (SAECG). SAECG is a feasible tool for assessing cardiac electrical changes in this population at risk for sudden cardiac death.
Area of Science:
- Cardiology
- Psychiatry
- Electrophysiology
Background:
- Sudden cardiac death (SCD) risk is elevated in psychiatric patients.
- Abnormal depolarization and late potentials (LPs) are linked to underlying conditions or treatments.
- QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) can detect these electrical abnormalities.
Purpose of the Study:
- To compare LP and QRSfr prevalence between psychiatric patients and controls.
- To assess the utility of SAECG in psychiatric patients.
- To prospectively follow patients for SCD incidence.
Main Methods:
- SAECG and QRSfr were used to detect LPs in 52 psychiatric patients and 30 healthy controls.
- Patients were monitored for SCD over a mean follow-up of 46 months.
Main Results:
- LP prevalence was significantly higher in psychiatric patients (31%) compared to controls (7%).
- The root mean square value at terminal 40msec of the QRS (RMS40) was lower in patients.
- No significant differences in LP or QRSfr were found based on patient demographics or medication.
- Three patients experienced SCD during follow-up.
Conclusions:
- Late potentials are more prevalent in psychiatric patients.
- SAECG is a practical and accessible method for evaluating myocardial electrophysiological alterations in psychiatric patients.
- Further research is needed to clarify the predictive value of LPs and QRSfr for SCD in this population.
Background:
Sudden cardiac death (SCD) occurs three times more often in psychiatric patients than in the general population. QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) are simple, inexpensive, readily available tools for detecting the presence of abnormal depolarization and late potentials (LPs) in these patients, a result of either the underlying disease or treatment.
Methods:
Frequency of LP detection by SAECG and QRSfr was studied in 52 psychiatric patients and compared with 30 healthy (without known structural heart disease or occurrence of ventricular arrhythmia) controls. Patients were then prospectively followed up and incidence of SCD was recorded.
Results:
LP prevalence was significantly higher in patients than in controls (16/52-31% vs 2/30-7%, p=0.012), while QRSfr was similar between these two groups (p=0.09). Of the LP presence criteria, the root mean square value at terminal 40msec of the QRS (RMS40) was significantly lower in patients (32μV, SD=19μV, vs 46μV, SD=32μV, p=0.015). Among patients, no differences were noted between the LP positive and negative groups regarding age, sex, number of medications, class of antipsychotics and defined daily doses. Mean follow-up was 46months (SD=11) and during it 3 patients suffered SCD. Although 2 SCD victims had both LPs and QRSfr concurrently present, neither of them, nor their simultaneous presence could definitely account for the events.
Conclusions:
LP prevalence in psychiatric patients was significantly higher than in controls. SAECG performance was feasible in all cases and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group.
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