title: Effects of tilt and exercise on signal-averaged electrocardiogram after acute myocardial infarction.
abstract: To determine whether enhanced sympathetic activity could alter a non-invasive index of cardiac instability, we analysed the effects of 90 degrees head-up tilt and submaximal exercise stress test on high amplification signal-averaged electrocardiogram in 64 patients after acute myocardial infarction. At rest, ventricular late potentials were detected in 25% of patients, characterized by a significant prolongation of filtered QRS complex (137 +/- 3 vs 115 +/- 2 ms) and of its components smaller than 40 microV (38 +/- 2 vs 16 +/- 1 ms), as well as by a reduced root mean square voltage calculated for the terminal 40 ms of QRS complex (RMS40 voltage) (19 +/- 1 vs 75 +/- 9 microV) in comparison to patients without micropotentials. Sympathetic activation induced by tilt caused a significant increase in heart rate (from 67 +/- 3 to 79 +/- 3 beats min-1) but did not modify either the incidence of ventricular late potentials or the values of any of the signal-averaged electrocardiogram parameters considered. In 19 patients, recordings were also obtained during a submaximal bicycle exercise stress test at a heart rate of 114 +/- 4 beats min-1 and with systolic arterial blood pressure at 153 +/- 6 mmHg. No effect on signal-averaged electrocardiogram parameters was detectable during this experimental intervention. These data indicate that after myocardial infarction, sympathetic activation does not seem to modify signal-averaged electrocardiogram parameters.
authors.affiliation: Patologia Medica, Centro Fidia, Cardiologia, Ospedale L. Sacco, Milano, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Lombardi
authors.forename: M L
authors.initials: ML
authors.lastname: Finocchiaro
authors.forename: L
authors.initials: L
authors.lastname: Dalla Vecchia
authors.forename: R
authors.initials: R
authors.lastname: Sala
authors.forename: M
authors.initials: M
authors.lastname: Garimoldi
authors.forename: G
authors.initials: G
authors.lastname: Baselli
authors.forename: S
authors.initials: S
authors.lastname: Cerutti
authors.forename: A
authors.initials: A
authors.lastname: Malliani
mesh_terms: D004562:Electrocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology; D011187:Posture / Q000502:physiology*; D012815:Signal Processing, Computer-Assisted; D013564:Sympathetic Nervous System / Q000503:physiopathology