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[Late potentials: non-invasive detection in coronary disease and relation to severe ventricular arrhythmia]
Insights
Ventricular late potentials (LP) are significant indicators of malignant ventricular arrhythmias in coronary heart disease (CHD) patients. Long-duration LPs, particularly with ventricular aneurysms, strongly predict these dangerous heart rhythm issues.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Context:
- Ventricular late potentials (LP) are subtle electrical signals detected during the QRS complex.
- Their clinical significance, especially in coronary heart disease (CHD), requires further elucidation.
- High-gain amplification and signal averaging are advanced techniques for detecting LPs.
Purpose:
- To determine the clinical significance of ventricular late potentials (LP) in patients with and without coronary heart disease (CHD).
- To investigate the association between LPs and the occurrence of ventricular tachycardia/fibrillation (VT/VF) and ventricular aneurysms.
- To assess the diagnostic and prognostic value of LPs in identifying patients at risk for malignant ventricular arrhythmias.
Summary:
- Late potentials (LP) were detected exclusively in patients with coronary heart disease (CHD), with a 50% prevalence in those with a history of ventricular tachycardia/fibrillation (VT/VF) and ventricular aneurysms.
- A significantly higher prevalence of LPs was observed in patients with VT/VF and ventricular aneurysms (80%) compared to those without.
- Long-duration LPs (>100 ms) were characteristic of patients with both VT/VF and ventricular aneurysms, and these LPs resolved post-surgical aneurysm resection.
Impact:
- Ventricular late potentials (LP), especially when prolonged, serve as a crucial hallmark for identifying malignant ventricular arrhythmias in coronary heart disease (CHD) patients.
- The findings highlight the prognostic value of LPs in risk stratification for sudden cardiac death in CHD.
- Detection and characterization of LPs can guide therapeutic strategies, including surgical intervention for ventricular aneurysms.
Abstract:
Using high-gain amplification and signal averaging techniques, we tried to determine the clinical significance of ventricular late potentials (LP). 85 subjects were included in this study. No LP were detected in normal subjects (n = 25), nor in patients with various non-coronary cardiopathies who had presented ventricular tachycardia and/or fibrillation (VT/VF) (n = 10). LP were recorded only in patients with coronary heart disease (CHD) (n = 50). The prevalence of LP was 50% (9/18) in patients with a history of VT/VF (vs 12.5% = 4/32 in patients without such a history, p less than 0.02). We also found a prevalence of 50% (11/22) in patients with a ventricular aneurysm (vs 7.1% = 2/28 in patients without an aneurysm, p less than 0.01). The prevalence reached 80% (8/10) in patients with VT/VF and a ventricular aneurysm and it was only in this latter group of patients that the interval between the peak of the R wave and the end of ventricular electrical activity exceeded 100 ms (mean 111.2 +/- 12 ms, vs 50 +/- 8 ms in normal subjects, p less than 0.001). In all the cases submitted to surgery, the LP disappeared after resection of the aneurysm. In conclusion, LP, when of long duration, should be considered as a hallmark of malignant ventricular arrhythmias in patients with CHD.