Signal-averaged electrocardiography (SAECG) is a special

electrocardiographic Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of t ...

technique, in which multiple electric signals from the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

are averaged to remove

interference Interference is the act of interfering, invading, or poaching. Interference may also refer to: Communications * Interference (communication), anything which alters, modifies, or disrupts a message * Adjacent-channel interference, caused by extra ...

and reveal small variations in the

QRS complex The QRS complex is the combination of three of the graphical deflections seen on a typical electrocardiogram (ECG or EKG). It is usually the central and most visually obvious part of the tracing. It corresponds to the depolarization of the ri ...

, usually the so-called "late potentials". These may represent a predisposition towards potentially dangerous ventricular tachyarrhythmias.

Technique

Procedure

A resting electrocardiogram (ECG) is recorded in the

supine position The supine position () means lying horizontally, with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic, and pericardium, pericardial ...

using an ECG machine equipped with SAECG software; this can be done by a

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...

, or medical technician. Unlike standard basal ECG recording, which requires only a few seconds, SAECG recording requires a few minutes (usually about 7-10 minutes), as the machine must record multiple subsequent QRS potentials to remove interference due to

skeletal muscle Skeletal muscle (commonly referred to as muscle) is one of the three types of vertebrate muscle tissue, the others being cardiac muscle and smooth muscle. They are part of the somatic nervous system, voluntary muscular system and typically are a ...

and to obtain a

statistically significant In statistical hypothesis testing, a result has statistical significance when a result at least as "extreme" would be very infrequent if the null hypothesis were true. More precisely, a study's defined significance level, denoted by \alpha, is the ...

average trace. For this reason, it is important for the patient to lie as still as possible during the recording.

Results

SAECG recording yields a single, averaged QRS potential, usually printed in a much larger scale than standard ECGs, upon which the SAECG software performs calculations to reveal small variations (typically 1-25 uV) in the final portion of the QRS complex (the so-called "late potentials, or more accurately, "late ventricular potentials"). These can be immediately interpreted by comparing results with cut-off values.

Significance

Late potentials are taken to represent delayed and fragmented

depolarisation In biology, depolarization or hypopolarization is a change within a cell, during which the cell undergoes a shift in electric charge distribution, resulting in less negative charge inside the cell compared to the outside. Depolarization is esse ...

of the ventricular

myocardium Cardiac muscle (also called heart muscle or myocardium) is one of three types of vertebrate muscle tissues, the others being skeletal muscle and smooth muscle. It is an involuntary, striated muscle that constitutes the main tissue of the wall o ...

, which may be the substrate for a micro-

re-entry Atmospheric entry (sometimes listed as Vimpact or Ventry) is the movement of an object from outer space into and through the gases of an atmosphere of a planet, dwarf planet, or natural satellite. Atmospheric entry may be ''uncontrolled entry ...

mechanism, implying a higher risk of potentially dangerous ventricular

tachyarrhythmias Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...

. This has been used for the risk stratification of

sudden cardiac death Cardiac arrest (also known as sudden cardiac arrest ''SCA is when the heart suddenly and unexpectedly stops beating. When the heart stops beating, blood cannot properly circulate around the body and the blood flow to the brain and other org ...

in people who have had a

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...

, as well as in people with known

coronary heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...

cardiomyopathies Cardiomyopathy is a group of primary diseases of the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An ...

, or unexplained syncope. Still, the real predictive value of these findings is questioned. Late potentials may be found in 0-10% of normal volunteers. When used as a prognostic factor for the development of

ventricular tachycardia Ventricular tachycardia (V-tach or VT) is a cardiovascular disorder in which fast heart rate occurs in the ventricles of the heart. Although a few seconds of VT may not result in permanent problems, longer periods are dangerous; and multiple ...

, they have a sensitivity of 72% and a specificity of 75%, yielding a

positive predictive value The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV desc ...

of 20% and a

negative predictive value The positive and negative predictive values (PPV and NPV respectively) are the proportions of positive and negative results in statistics and diagnostic tests that are true positive and true negative results, respectively. The PPV and NPV desc ...

of 20%.

References

* {{PMID, 8522703 -

American College of Cardiology The American College of Cardiology (ACC), based in Washington, D.C., is a nonprofit medical association established in 1949. It bestows credentials upon cardiovascular specialists who meet its qualifications. Education is a core component of the ...

Expert Consensus Document (1996): Signal-averaged Electrocardiography, J Am Coll Cardiol. 1996 Jan;27(1):238-49. * Drew Provan and Andrew Krentz (editors), Oxford Handbook of Clinical and Laboratory Investigation,

Oxford University Press Oxford University Press (OUP) is the publishing house of the University of Oxford. It is the largest university press in the world. Its first book was printed in Oxford in 1478, with the Press officially granted the legal right to print books ...

, 2003 corrected edition.

External links

SAECG and Late potentials
- epCINRE Cardiac electrophysiology