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European Heart Journal 1991 12(5):590-596;
Copyright © 1991 by the European Society of Cardiology.
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© 1991 The European Society of Cardiology

Comparison of different orthogonal systems in high resolution ECGs and the significance of the number of averaged beats in detecting late potentials

A. H. PIETERSEN and E. GYMOESE

Medical Department B, Rigshospitalet, Copenhagen University Hospital Copenhagen, Denmark

Received 14 April 1989; revised 7 August 1990; .

Correspondence: A. H. Pietersen MD. Medical Department B-2012 Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark

Abstract

For non-invasive detection of late potentials in the signal-averaged electrocardiogram (SAECG) most studies use modified orthogonal leads. In the present study the significance of three different lead systems for the detection of late potentials was examined. SAECGs were recorded aifive different (32,64, 128,256 and 5l2) numbers of averaged beats in 24 patients with ventricular tachycardia after myocardial infarction and in 76 normal subjects. The original Frank leads and two different modified orthogonal vector lead systems were used. There was no clinicald between the three orthogonal systems in sensitivity and the difference in specificity (P<0·01) seemed to be primarily related to dtfferences in noise content. When the vector systems were compared at equally low noise levels of 0·47–0·50 µV, the apparent differences in specificity between the vector systems disappeared. At decreasing noise levels the sensitivity increased, at the cost of a loss in specificity which at very low noise levels was out of proportion with the gain in sensitivity. A modified approach with afixed threshold noise level to determine the QRS endpoint is suggested.

Key Words: Signal-averaging • late potentials • orthogonal leads • methodology


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