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Endocardial late potentials recorded during sinus rhythm in man: incidence in different cardiac disease states
K P Bethge1, B D Gonska, H Kreuzer
1Department of Cardiology, University of Goettingen, Federal Republic of Germany.
Insights
Left ventricular endocardial late potentials are common in various heart diseases, particularly coronary heart disease. These abnormal signals may indicate patchy fibrosis in the heart muscle.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Imaging
Background:
- Late potentials are abnormal electrical signals in the heart.
- Their prevalence and characteristics in diverse cardiac conditions require further investigation.
Purpose of the Study:
- To investigate the occurrence and nature of left ventricular endocardial late potentials in patients with various cardiac diseases.
- To compare the prevalence of late potentials between coronary heart disease and dilative cardiomyopathy.
Main Methods:
- Prospective study involving 100 patients with diverse cardiac conditions.
- Left ventricular endocardial mapping using a quadripolar catheter at 10 positions per patient.
- Analysis of electrograms for the presence, type, and timing of late potentials.
Main Results:
- Late potentials were detected in 90% of patients (90/100).
- Significantly higher prevalence in coronary heart disease (50/52) versus dilative cardiomyopathy (26/34, p<0.025).
- Diastolic late potentials were most common (82 patients); fractionated electrograms were more frequent in coronary patients (27/52) than cardiomyopathy patients (8/34, p<0.025).
Conclusions:
- Endocardial late potentials are frequently observed in patients with various cardiac diseases.
- Their higher incidence in coronary heart disease suggests patchy myocardial fibrosis.
- Late potentials, especially fractionated ones, may serve as indicators of specific myocardial pathologies.
Abstract:
In a prospective study, 100 patients with various cardiac diseases not selected on the basis of previous ventricular arrhythmias underwent left ventricular endocardial mapping. With 10 different positions of the quadripolar catheter per patient, 90 of the 100 patients showed late potentials. These findings were documented in 50 of 52 patients with coronary heart disease compared to 26 of 34 patients with dilative cardiomyopathy (p less than 0.025). Late potentials in diastole were the most frequent type of abnormal electrogram, found in 82 patients. Fractionated electrograms were documented in 43 patients. They were seen in 27 (52%) coronary patients more often than in 8 (24%) patients with dilative cardiomyopathy (p less than 0.025). Onset of fractionated electrograms in coronary patients was somewhat later (301 +/- 177 ms after the QRS) than in the cardiomyopathy group (263 +/- 141 ms). The duration was longer (189 +/- 114 ms) in the former group than in the latter (148 +/- 87 ms). Thus, endocardial late potentials are not uncommon in patients with various cardiac diseases. The more frequent occurrence in coronary heart disease and the higher frequency of fractionated electrograms may indicate a more inhomogeneous, patchy type of fibrosis in the ischemically diseased myocardium.