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European Heart Journal 1990 11(5):421-428;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

Effects of tilt and exercise on signal-averaged electrocardiogram after acute myocardial infarction

F. LOMBARDI1, M. L. FINOCCHIARO, L. DALLA VECCHIA, R. SALA, M. GARIMOLDI, G. BASELLI, S. CERUTTT and A. MALLIANI

Patologia Medica, Centro ‘Fidia’, Cardiologia, Ospedale L. Sacco; Istituto Ricerche Cardiovascolari, Centro Ricerche Cardiovascolari CNR, Universitä andDipartimento Elettronica Politecnico, Milano, Italy

Received 3 May 1989; revised 4 July 1989; .

1Correspondence: Federico Lombardi, Instituto Ricerche Cardiovascolari, CNR, via Bonfadini 214, 20138 Milano, Italyu.

Abstract

To determine whether enhanced sympathetic activity could alter a non-invasive index of cardiac instability, we analysed the effects of 90° 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 fiV (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 ± 9µV) 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.

Key Words: Signal-averaged electrocardiogram • sympathetic activation


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