Risk factors of malignant arrhythmia and predictive value of late ventricular potential in the patients with first episode depression disorder / 中华行为医学与脑科学杂志

Objective:To explore the risk factors of the incidence of arrhythmia and the prediction of baseline ventricular late potential in patients with first depression episode.Methods:The cohort study was used to observe the relationship between the baseline status of ventricular late potential, the severity of baseline depression symptoms, the extent of remission of depressive symptoms within the treatment duration and arrhythmia incidence in the 3 years progress. For the assessment of the severity of depression symptoms, 17 version of Hamilton depression scale was used to evaluate the baseline ventricular late potential, and DMS lab3.0 ECG platform late potential analysis system was used to determine the assessment (CardioScan 12 NET version). The first depression patients with positive ventricular late potential were followed up for 3 years. The changes of the severity of ventricular late potential and depression symptoms were investigated, and the correlation with the subsequent course of arrhythmia was investigated.SPSS 20.0 software package was used for statistical distraction, chi square test was used for count data, independent samples t test was used for normal distribution measurement data, Mann-Whitney U test was used for non-normal distribution count data, and logistic regression method was used to calculate relative risk( RR). Results:According to the 3-year follow-up of 400 first-episode depression patients, 22.25% (89/400) had malignant arrhythmia. The incidence of malignant arrhythmia was 39.46% (58/147) in ventricular late potential positive group and 12.25% (31/253) in ventricular late potential negative group, and the difference was statistically significant(χ 2=9.578, P<0.01). Logistic regression analysis showed that positive ventricular late potential at baseline (compared with negative ventricular late potential at baseline, RR=10.78, 95% CI=8.34-13.80), having a family history of arrhythmia (compared with no family history of arrhythmia, RR=5.23, 95% CI=2.41-9.85), had a higher severity of depression at baseline (compared with lower severity of depression at baseline, RR=1.73, 95% CI=1.25-2.85), poor first-time efficacy and more repeated hospitalizations (compared with good first-time efficacy and less hospitalizations, RR=1.11, 95% CI=1.04-1.17), and age of onset< 20 (compared with age of onset≥20, RR=1.07, 95% CI=1.02-1.93) were the risk factors of malignant arrhythmia in patients with first-episode depression(all P<0.05). Conclusion:The incidence of arrhythmia is very high in those patients with baseline positive late ventricular potential. Positive late ventricular potential, family history of arrhythmia, younger onset age and poor therapeutic effect were the relative risk of arrhythmia in the patients with depression.

Changes in ventricular late potentials in children and adolescents with postural tachycardia syndrome / 中华实用儿科临床杂志

Objective To investigate the changes in ventricular late potentials (VLP) in children and adolescents with postural tachycardia syndrome (POTS).Methods One hundred and forty-four children and adolescents diagnosed as POTS by using the head-up tilt test (HUTT) in Second Xiangya Hospital of Central South University from January 2012 to March 2019 were selected as POTS group,their age ranged 4 to 16 years old [(11.03 ± 2.34) years old],there were 65 boys and 79 girls.Ninety-one healthy children and adolescents matched by age and gender [aged 4-16 (11.22 ± 1.68) years old,there were 50 boys and 41 girls] were selected as the healthy control group.VLP was measured by SR-1000A ECG automatic analyzer (Boai,Guangdong,China).Results Compared with the healthy control group,the prevalence of positive VLP in the POTS group increased [11.1％ (16/144 cases)vs.1.1％ (1/91 cases)],and the difference was statistically significant(x2=6.904,P ＜ 0.01);the heart rate in the POTS group increased compared with that in the healthy control group [82.0 (74.0-95.0) times/min vs.78.0 (71.0-86.0) times/min],and the difference was statistically significant (Z =-2.265,P ＜ 0.05);the low-amplitude signal (LAS40) in the POTS group prolonged compared with that in the healthy control group[23.0 (17.0-31.0) μV vs.19.0 (13.0-25.0) μV],and the difference was statistically significant (Z =-4.114,P ＜ 0.01);root mean square amplitude(RMS40) increased compared with that in the healthy control group [61.3 (34.4-79.1) ms vs.52.0 (38.8-64.5) ms],and the difference was statistically significant (Z =-2.469,P ＜ 0.05).There was no statistically significant difference in total QRS time (TQRS) between 2 groups [86.0 (76.0-97.5) ms vs.87.0 (81.0-94.0) ms,Z =-0.007,P ＞ 0.05].Conclusions The positive rate of VLP is increased of children and adolescents with POTS.It suggests that there is an abnormal cardiac electrical activity in children and adolescents with POTS.

Changes in ventricular late potentials in children and adolescents with postural tachycardia syndrome / 中华实用儿科临床杂志

Objective@#To investigate the changes in ventricular late potentials (VLP) in children and adolescents with postural tachycardia syndrome (POTS).@*Methods@#One hundred and forty-four children and adolescents diagnosed as POTS by using the head-up tilt test (HUTT) in Second Xiangya Hospital of Central South University from January 2012 to March 2019 were selected as POTS group, their age ranged 4 to 16 years old[(11.03±2.34)years old], there were 65 boys and 79 girls.Ninety-one healthy children and adolescents matched by age and gender[aged 4-16 (11.22±1.68) years old, there were 50 boys and 41 girls]were selected as the healthy control group.VLP was measured by SR-1000A ECG automatic analyzer (Boai, Guangdong, China).@*Results@#Compared with the healthy control group, the prevalence of positive VLP in the POTS group increased [ 11.1%(16/144 cases)vs.1.1%(1/91cases)], and the difference was statistically significant(χ2= 6.904, P<0.01); the heart rate in the POTS group increased compared with that in the healthy control group[82.0 (74.0-95.0) times/min vs.78.0 (71.0-86.0) times/min], and the difference was statistically significant(Z=-2.265, P<0.05); the low-amplitude signal(LAS40) in the POTS group prolonged compared with that in the healthy control group[23.0 (17.0-31.0) μV vs.19.0 (13.0-25.0) μV], and the difference was statistically significant(Z=-4.114, P<0.01); root mean square amplitude(RMS40) increased compared with that in the healthy control group[61.3 (34.4-79.1) ms vs.52.0 (38.8-64.5) ms], and the difference was statistically significant (Z=-2.469, P<0.05). There was no statistically significant difference in total QRS time (TQRS) between 2 groups [86.0 (76.0-97.5) ms vs.87.0 (81.0-94.0) ms, Z=-0.007, P>0.05].@*Conclusions@#The positive rate of VLP is increased of children and adolescents with POTS.It suggests that there is an abnormal cardiac electrical activity in children and adolescents with POTS.

The changes of ventricular late potentials in patients with neurally mediated syncope / 中国小儿急救医学

Neurally mediated syncope children have autonomic nervous system dysfunction.Ventricular late potentials is closely related to the autonomic nerve function and is an index for predicting the occurrence of malignant arrhythmia.Understanding the changes of ventricular late potentials have a certain value in predicting cardiovascular disease of neurally mediated syncope children.

Differences of ventricular late potential between acute STEMI and NSTEMI patients / Diferencias del potencial tardío ventricular entre pacientes con infartos agudos STEMI y NSTEMI

OBJECTIVE: To discuss the positive rate of ventricular late potential (VLP) between patients with acute ST-segment elevation myocardial infarction (STEMI) and patients with acute non NSTEMI. METHODS: One hundred and sixty-three cases of acute myocardial infarction (90 patients with STEMI and 73 with NSTEMI), admitted to the first hospital of China Medical University between June 2011 and August 2011, underwent VLP examination. RESULTS: The VLP positive rate of the STEMI group was 54.4%, while that of the NSTEMI group was 38.4%, and the differences have statistical meaning (χ2 = 4.186, p < 0.05). The occurrence rate of ventricular arrhythmia in VLP positive patients was 11.7%, while in VLP negative patients it was 3.5% (χ2 = 4.005, p < 0.05). CONCLUSION: The VLP positive rate of the STEMI group is higher than that of the NSTEMI group.

OBJETIVO: Analizar la tasa positiva del potencial tardío ventricular (PTV) entre pacientes con infarto agudo del miocardio sin elevación del segmento ST (NSTEMI por sus siglas en inglés) y el infarto agudo del miocardio con elevación del segmento ST (STEMI por sus siglas en inglés). MÉTODOS: Ciento sesenta y tres casos de infarto agudo de miocardio (90pacientes con STEMI) y 73 con NSTEMI, ingresados en la Universidad primer hospital de Medicina China entre junio y agosto de 2011, fueron sometidos a examen de PTV. RESULTADOS: La tasa positiva PVT del grupo STEMI fue 54.4%, mientras que la del grupo NSTEMI fue 38.4%, y las diferencias tienen significado estadístico (χ² = 4.186, p < 0.05). La tasa de ocurrencia de arritmia ventricular en pacientes PVTpositivos fue 11.7%, mientras que en los pacientes PVT negativos fue 3.5% (χ² = 4.005, p < 0.05). CONCLUSIÓN: La tasa PTV positiva del grupo STEMI es mayor que la del grupo NSTEMI.

High-resolution electrocardiography in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxer dogs / Eletrocardiografia de alta resolução no diagnóstico da cardiomiopatia arritmogênica do ventrículo direito em cães da raça Boxer

To evaluate the reliability of high-resolution electrocardiography in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxers, 20 dogs with no structural cardiac alterations at echocardiographic examination were grouped on the basis of frequency of ventricular arrhythmias, evaluated by 24-hour ambulatory ECG, and undergoing a high-resolution electrocardiography. High frequency QRS duration, duration of terminal QRS complex less than 40µV (LAS40) and root mean square voltage of the terminal 40 milliseconds of the QRS complex (RMS40) were measured. Differences in high-resolution ECG variables were not observed between groups. Therefore, the results of this investigation suggest that high-resolution electrocardiography is not a useful method for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in Boxers without detectable myocardial alterations or systolic dysfunction.

Com o objetivo de avaliar a importância da eletrocardiografia de alta resolução no diagnóstico da cardiomiopatia arritmogênica do ventrículo direito do Boxer, 20 cães sem evidências de doença cardíaca estrutural à avaliação ecodopplercardiográfica foram agrupados de acordo com a frequência de arritmias ventriculares, avaliadas pela eletrocardiografia ambulatorial de 24 horas, e submetidos ao exame eletrocardiográfico de alta resolução. Duração do complexo QRS filtrado, duração dos sinais de baixa amplitude (menor que 40µV) dos últimos 40 milissegundos do complexo QRS e raiz quadrada média da voltagem ao quadrado dos últimos 40 milissegundos do complexo QRS (RMS40) foram as variáveis avaliadas. Não foram observadas diferenças significativas entre os grupos em relação às variáveis estudadas. Sendo assim, os resultados do presente estudo sugerem que a eletrocardiografia de alta resolução não é uma ferramenta útil no auxílio diagnóstico da cardiomiopatia arritmogênica do ventrículo direito dos cães da raça Boxer que não apresentam alterações miocárdicas evidentes ou disfunção sistólica.

Prediction and stratification of the future cardiovascular arrhythmic events: Signal averaged electrocardiography versus ejection fraction.

Cardiac arrhythmias as cause of sudden cardiac death remains an important public health problem. The availability of effective treatment in terms of the implantable defibrillator makes it critical to identify individuals at risk. An essential step in this process is the use of noninvasive techniques to screen patients and identify those at risk. The detection of ventricular late potential using the SAECG as a non-invasive technique is being explored for this purpose. The objective of the study was to stratify the future cardiovascular events including life threatening cardiac arrhythmias, in different cardiac diseases through positive and negative predictive values of SAECG and comparing with EF% another mechanical determinant. The study was conducted on 152 subjects selected from the OPD and admitted case of the New Civil Hospital and Govt. Medical College, Surat; between 25 to 75 years of age group, from August 2001 to June 2004. 80 healthy subjects free from any major acute/chronic illness were selected as a control using our own normative values for SAECG. The statistical analysis was performed using SPSS package. The results obtained were analyzed for significance by using Chi square and Independent ‘t’ test. When we compared the cardiac arrhythmic events on 6 month follow-up study, based on SAECG and EF% separately we found that negative predictive value of SAECG was more (99.1%) than negative predictive value of EF% (93.6%). However positive predictive values for cardiac arrhythmic events of SAECG were less (28.9%) compare to EF% (42.9%).When both the parameters SAECG and EF% are considered together the negative as well as positive predictive values of these tests were quite high (100% and 50% respectively). In this study conducted on 152 patients we found that SAECG and EF% together were an accurate predictor of the cardiac arrhythmic events in terms of positive and negative predictive value while SAECG or EF% alone were not. However SAECG has got a more negative predictive value compare to EF%. In this study SAECG compared favorably or even better than EF% for risk stratification. SAECG and EF% together (and not separately) may be considered as a better investigational tool to stratify future cardiovascular arrhythmic events.

High-resolution electrocardiography in dogs under doxorubicin-induced cardiomyopathy / Eletrocardiografia de alta resolução em cães com cardiomiopatia induzida pela doxorrubicina

The occurrence of late potentials in dogs under doxorubicin-induced cardiomyopathy and their relationship with the development of ventricular arrhythmias or sudden death were studied. Seven adult mongrel dogs of both sexes were used. Cardiomyopathy was induced by slow intravenous infusion of doxorubicin (30mg/m²) at 21-day intervals, until a total cumulative dose of 240mg/m² was reached. Animals were monitored by echocardiography. After the induction of cardiomyopathy, high-resolution electrocardiography was recorded. Late potentials were observed in two animals that suddenly died a few days later.

Determinaram-se a ocorrência de potencial tardio em cães com cardiomiopatia induzida pela doxorrubicina e sua relação com o desenvolvimento de arritmias ventriculares ou morte súbita. Sete cães adultos, sem raça definida, de ambos os sexos foram utilizados. A cardiomiopatia foi induzida por infusão venosa lenta de doxorrubicina (30mg/m²) em intervalos de 21 dias, até uma dose total cumulativa de 240mg/m². Os animais foram monitorados ecocardiograficamente. Após a confirmação da cardiomiopatia, foi feito o registro da eletrocardiografia de alta resolução. Potenciais tardios foram observados em dois animais que morreram subitamente poucos dias após.

The Effect of Hemodialysis on Signal-Averaged Electrocardiography (SAECG) in Patients with End-Stage Renal Disease / 대한신장학회잡지

BACKGROUND: The presence of late potentials on the signal-averaged electrocardiography (SAECG) is predictive of ventricular tachycardia and sudden cardiac death. We investigated the acute effect of HD on the SAECG in patients with end-stage renal disease (ESRD). METHODS: Twenty HD patients with normal sinus rhythm on a routine ECG were enrolled. SAECGs were recorded immediately before, within 30 minute after, and then 24 hour after the completion of HD. Serum electrolyte, BUN, calcium, echocardiogram and body weight were examined before and after the HD. RESULTS: Positive late potentials on SAECG were detected in 8 patients (40%) before HD, 12 patients (60%) at 30 minute after HD, and 5 patients (25%) at 24 hour after HD. There was a significant change in QRSd (QRS duration) after HD: (110.3+-9.7 msec before HD; 112.3+-9.3 msec at 30 minute after HD; 109.5+-8.6 msec at 24 hour after HD) (p<0.05). The reduction of serum potassium was greater in positive late potential (n=12) than in negative late potential group after HD (n=8) (p<0.05). A significant negative correlation was seen between the changes of dialysis-induced serum total CO2 and QRSd changes (r=-0.534, p<0.05). CONCLUSION: SAECG parameters tended to be aggravated after HD in patient with ESRD. Prolongation of QRSd after HD could be explained by the changes of potassium and bicarbonate.

The study of long-term ventricular late potential in the acute myocardial infarction / 中国实用内科杂志

Objectives This study aimed at finding cut if reperfusion could be identified by long term VLP,using digital Holter ECG.Methods 24 hour 3 channel digital Holter recorders were performed on 38 patients with AMI before thrombolytic therapy,then the patients were divided into successful reperfusion group and unsuccessful reperfusion group.Every parameter was comparied between the two groups.Results VLP parameters showed a gradual improvement in the acute phase of MI in patients with successful reperfusion compared with those of unsuccessful reperfusion and that a significant difference between these two groups became evident from 2～3 hour after thrombolysis.Conclusions Our investigation certifies that successful reperfusion reduces VLP positive rate significantly 2～3 hours after thrombolysis.Thus,long term ventricular late potential may be helpful for identification of the reperfusion in AMI patients.In the mean time,Our study is performed before the formation of myocardial fibrous scar in AMI patients,it breaks up the traditional concept that VLP only developed from the formation of myocardial fibrous scar.

Age-Related Criteria for Signal-Averaged Electrocardiographic Late Potentials in Children

PURPOSE: Ventricular late potentials have been shown to predict malignant ventricular arrhythmia and sudden cardiac death in patients with myocardial infarction and cardiomyopathy. Low amplitude and high frequency potentials at the end of the QRS complex can be detected on the body surface using signal-averaged electrocardiogram(SAECG). This study determines the age-related criteria of SAECG parameters and age-related differences. METHODS: SAECGs were obtained in 58 healthy children in five age groups(98ms, RMS4027ms, and LD>40ms for 109ms, RMS4020ms, and LD>49ms for 1-11mo; f-QRS>114ms, RMS4033ms, and LD>39ms for 1-5yr; f-QRS>112ms, RMS4030ms, and LD>45ms for 6-11yr; f-QRS>117ms, RMS4037ms, and LD>30ms for 12-15yr. RMS40 and LAS correlated with f-QRS duration(r=-0.75, and 0.45 respectively, P<0.05), suggesting that these parameters are associated with ventricular muscle thickness and ventricular conduction time. CONCLUSION: Age-related differences in SAECG parameters may be due to ventricular muscle thickness and ventricular conduction time. This should be considered for the evaluation of ventricular late potential.

Relation between QT Dispersion and Late Potential in Acute Myocardial Infarction

BACKGROUND: QT dispersion(QTD=QTmax-QTmin) on the 12 lead ECG has been known to reflect regional variation of ventricular repolarization, and thus a marker of an increased risk of arrhythmia events. Late potential(LP) on signal averagina ECG(SAECG) is independent risk factor of ventricular arrhythmia following acute myocardial infaction(AMI). However, the relation between LP and QTD as indicator of electrophysiologic instability in AMI remains to be determined. METHOD: To determine whether there is a difference in QTD between in parients with AMI during acute phase and in normal control and whether thrombolytic therapy is assiciated with a reduction in QTD, and to determine the relationship between change of QTD and late potential on SAECG, we studied 71 patient with AMI(male 54, female 14, mean age 57yrs) and 23 controls(malw 17, female 6, mean age 58yrs). QT interval was measured on a standard 12 lead ECG in patients with AMI on admission, 2 hours after urokinase IV and 10-14 days post-AMI, and QT dispersion was calculated by difference of maximal and minimal corrected QT interval(QTmax-QTmin). A signal averaged ECG was recorded in 36 patients before discharge and coronary angiogeaphy(CAG) was performed in all patients 10-14 days post-AMI. RESULT: QTD is significantly increased in AMI compared to control(78.7+/-39.5ms vs. 24.6+/-22.3ms, P < 0.01). In patients who received thrombolytic therapy with urokinase, QTD is decreased from 75.0+/-34.4ms to 53.9+/-36.0ms(P < 0.01), whereas there is no significant change in patients who did not received thrombolytic therapy(84.8+/-47.6ms vs. 78.9+/-36.2ms, NS). There in no difference in QTD between patients with positive LP(68.4+/-23.6ms) and those with negative LP(77.8+/-32.1ms) on admission, those with positive LP(66.6+/-27.6ms) and those with negative LP(56.0+/-26.4ms) after 10-14days post-AMI. But magnitude of change of 10-14 days post-AMI QTD in patients with negative LP is larger than those with positive LP(-21.7+/-33.4ms vs. -1.8+/-15.2ms, P=0.06). CONCLUSION: QTD in acute phase of AMI is significantly reduced by the thrombolytic therapy. Patients with negative late potential tent to have greater QTD reduction within 14 days after AMI. These finding suggest that QT dispersion in patients with AMI can be reduced by early recanalization and its reduction is associated with the presence of late potential.

The Relationship between Ventricular Arrhythmia in Patients with Myocardial Infarction and Ventricular Late Potential

Ventricular arrhythmia is known as a major cause of sudden death in patients with heart disease, especially in patients with myocardial infarct. Programmed electrical stimulation (PES) is used in order to identify patients with high risk of ventricular arrhythmia, but it is invasive. So ventricular late potential is studied, which can be performed safely. Ventricular late potential was measured in the 65 normal subjects, 17 patients with in-hospital period acute myocardial infarction and 29 patients with old myocardial infarction using signal-averaged high resolution EKG, Mac-15. The positive criteria of ventricular late potential was one of the following : The duration of TQRS is more than 120 msec, or the amplitude of RMS is less than 25microV, or the duration of LP 40 is more than 40 msec. The results are as follows : 1) Among 65 normal subjects(male ; 33, female ; 32), total QRS duration(TQRS)was 103.9+/-8.3msec(mean S.D), terminal 40msec root mean square amplitude(RMS) 47.8+/-24.3uV and terminal 40msec mean amplitude was 32.5+/-15.4uV. Variables of ventricular late potential showed no significant difference by age. 10 subjects showed positive ventricular late potential. 2) Among 17 patients with in-hospital period myocardial infarction, there was no significant difference in variables of ventricular late potential between patients with ventricular arrhythmia(3 subject) and patients without ventricular arrhythmia(14 subjects). 3) Among 29 subjects with old myocardial infarction, TQRS showed significant differrence between patients with ventricular arrhythmia(3 subjects) and patients without ventricular arrhythmias(26 subjects). All of the patients with ventricular arrhythmia(100%) and 6 subjects(24%) of the patients without ventricular arrhythmia showed positive ventricular late potential, and the difference was significant statistically between groups(p value<0.05). This showed that ventricular late potential is helpful in predicting the risk of ventricular arrhythmia among patients with old myocardial infarction.