Current usefulness of the signal-averaged electrocardiogram

Signal-averaged electrocardiography is a relatively simple, noninvasive technique by which valuable information can be gained to help in the management of patients with cardiovascular disease. The presence of late potentials on the SAECG is a good marker for the presence of an arrhythmogenic substrate that is believed to be the source of ventricular tachycardia in patients with coronary artery disease. The value of the detection of late potentials has been studied best after myocardial infarction, when the absence of late potentials makes the occurrence of an arrhythmic event very unlikely. The positive predictive value for an arrhythmic event to occur in the presence of late potentials is low, however, comparable to the predictive value of decreased left ventricular function, complex ventricular ectopy, or abnormal autonomic tone. This appears to have its explanation in the complex pathophysiology behind the occurrence of arrhythmic events. Improved accuracy for the SAECG is achieved when the result of the test is interpreted with consideration of the presence or absence of other predictive markers. A thorough understanding of the signal-averaged electrocardiogram makes optimal clinical use of the information gained from this easily acquired test possible.