Usefulness of late potentials on the immediate postoperative signal-averaged electrocardiogram in predicting ventricular tachyarrhythmias early after isolated coronary artery bypass grafting.
The present study was undertaken to determine the value of abnormal late ventricular potentials on signal-averaged electrocardiograms (ECG) in identifying patients at risk of developing ventricular tachycardia or ventricular fibrillation in the early postoperative period after coronary artery bypass grafting. Signal-averaged ECGs were recorded immediately after operation in 72 patients. Abnormal late potentials were defined as the presence of 2 or 3 of the following: (1) root-mean-square amplitude of the last 40 ms of the QRS < 20 microV; (2) duration of the terminal QRS potentials (after 40 microV) > or = 39 ms; and (3) high-frequency QRS duration > 120 ms (in patients with conduction defects, only the first 2 criteria were used). Abnormal late ventricular potentials were present on the immediate postoperative signal-averaged ECG in 26 of the 72 patients (36%). Life-threatening ventricular tachyarrhythmias occurred in 6 patients. Late potentials were present in all 6 patients, but only in 20 of 66 (30%) who did not develop ventricular tachyarrhythmias (p < 0.005) (sensitivity 100%, specificity 70%, predictive accuracy 72%). Of 12 pre- and perioperative variables examined by univariate and multivariate regression analysis, the presence of late potentials on the signal-averaged ECG and low cardiac output postoperatively were found to be independent predictors of life-threatening tachyarrhythmias.
Department of Cardiothoracic Surgery, Lady Davis Carmel Hospital, Haifa, Israel.
A
A
Elami
G
G
Merin
M Y
MY
Flugelman
L
L
Adar
E
E
Rudis
D A
DA
Halon
B S
BS
Lewis
D000200:Action Potentials; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D012815:Signal Processing, Computer-Assisted; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000503:physiopathology