Prevalence of late potentials on signal-averaged ECG in patients with psychiatric disorders

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• 作者：Christos-Konstantinos Antoniou^a ; ¹ ; Ippokratis Bournellis^a ; ¹ ; Achilleas Papadopoulos^b ; ¹ ; Dimitris Tsiachris^a ; ¹ ; Petros Arsenos^a ; ¹ ; Polychronis Dilaveris^a ; ¹ ; Ioannis Diakogiannis^c ; ¹ ; Skevos Sideris^d ; ¹ ; Ioannis Kallikazaros^d ; ¹ ; Konstantinos A. Gatzoulis^a ; ¹ ; ^{kgatzoul@med.uoa.gr" class="auth_mail" title="E-mail the corresponding author} ; Dimitrios Tousoulis^a ; ¹
• 关键词：CAD ; coronary artery disease ; SCD ; sudden cardiac death ; SAECG ; signal-averaged electrocardiography ; LPs ; late potentials ; QRSfr ; QRS fragmentation ; fQRS ; filtered QRS ; LAS ; low amplitude signal ; RMS40 ; root mean square value at terminal 40  ; msec of QRS ; QTc ; rate corrected QT ; DDD ; defined daily dose ; EF ; ejection fraction
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：557-561
• 全文大小：532 K

文摘

Sudden cardiac death (SCD) occurs three times more often in psychiatric patients than in the general population. QRS fragmentation (QRSfr) and signal-averaged electrocardiography (SAECG) are simple, inexpensive, readily available tools for detecting the presence of abnormal depolarization and late potentials (LPs) in these patients, a result of either the underlying disease or treatment.

Methods

Frequency of LP detection by SAECG and QRSfr was studied in 52 psychiatric patients and compared with 30 healthy (without known structural heart disease or occurrence of ventricular arrhythmia) controls. Patients were then prospectively followed up and incidence of SCD was recorded.

Results

LP prevalence was significantly higher in patients than in controls (16/52–31% vs 2/30–7%, p = 0.012), while QRSfr was similar between these two groups (p = 0.09). Of the LP presence criteria, the root mean square value at terminal 40 msec of the QRS (RMS40) was significantly lower in patients (32 μV, SD = 19 μV, vs 46 μV, SD = 32 μV, p = 0.015). Among patients, no differences were noted between the LP positive and negative groups regarding age, sex, number of medications, class of antipsychotics and defined daily doses. Mean follow-up was 46 months (SD = 11) and during it 3 patients suffered SCD. Although 2 SCD victims had both LPs and QRSfr concurrently present, neither of them, nor their simultaneous presence could definitely account for the events.

Conclusions

LP prevalence in psychiatric patients was significantly higher than in controls. SAECG performance was feasible in all cases and constitutes a readily available tool for assessing myocardial electrophysiological alterations in this patient group.