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Prognostische Bedeutung ventrikulärer Spätpotentiale bei Postinfarktpatienten und Patienten mit stabiler koronarer Herzkrankheit

  • G. Breithardt
  • M. Borggrefe
  • K. Haerten
  • J. Schwarzmaier
  • U. Karbenn
  • A. Podczeck
Conference paper

Zusammenfassung

Bei Patienten mit dokumentierten ventrikulären Tachyarrhythmien lassen sich an der Körperoberfläche mit Hilfe der Signalmittelungstechnik niederamplitudige, fraktionierte Potentiale am Ende des QRS-Komplexes nachweisen, die sich in die ST-Strecke erstrecken (1, 2, 11, 13, 20, 21, 24). Diese Signale werden im allgemeinen als ventrikuläre Spätpotentiale bezeichnet (11). Die bisherigen Beobachtungen sprechen dafür, daß sie eine enge Beziehung zur Tachykardieneigung aufweisen (2–5, 13, 20, 21). Aufgrund intraoperativer Messungen sowie von Befunden des endokardialen in pressetermappings ist es wahrscheinlich, daß diese Signale aus dem Randgebiet alter Infarkte stammen (9, 12, 15, 17, 22, 23, 27).

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Literatur

  1. 1.
    Berbari EJ, Scherlag BJ, Hope RR, Lazzara R (1978) Recording from the body surface of arrhythmogenic ventricular activity during ST segment. Am J Cardiol 41: 697–702PubMedCrossRefGoogle Scholar
  2. 2.
    Breithardt G, Becker R, Seipel L, Abendroth R-R, Ostermeyer J (1981) Noninvasive detection of late potentials in man - a new marker for ventricular tachycardia. Eur Heart J 2: 1–11PubMedGoogle Scholar
  3. 3.
    Breithardt G, Borggrefe M, Karbenn U, Abendroth R-R, Yeh HL, Seipel L (1982) Prevalence of late potentials in patients with and without ventricular tachycardia: Correlation with angiographic findings. Am J Cardiol 49: 1932–7PubMedCrossRefGoogle Scholar
  4. 4.
    Breithardt G, Schwarzmaier J, Borggrefe M, Haerten K, Seipel L (1983) Prognostic significance of ventricular late potentials after acute myocardial infarction. Eur Heart J 4: 487–95PubMedGoogle Scholar
  5. 5.
    Breithardt G, Borggrefe M, Quantius B, Karbenn U, Seipel L (1983) Ventricular vulnerability assessed by programmed ventricular stimulation in patients with and without late potentials. Circulation 68: 275–81PubMedCrossRefGoogle Scholar
  6. 6.
    Breithardt G, Borggrefe M; Haerten K (1985) Role of programmed ventricular stimulation and noninvasive recording of ventricular late potentials for the identification of patients at risk of ventricular tachyarrhythmias after acute myocardial infarction. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology and arrhythmias. Grune Stratton, New York, pp 553–561Google Scholar
  7. 7.
    Breithardt G, Borggrefe M, Haerten K (1986) Ventricular late potentials and inducible ventricular tachyarrhythmias as a marker for ventricular tachycardia after myocardial infarction. Eur Heart J 7, Suppl A: 127Google Scholar
  8. 8.
    Cats VM, Lie KI, van Capelle FJL, Durrer D (1979) Limitations of 24 hour ambulatory electrocardiographic recording in predicting coronary events after acute myocardial infarction. Am J Cardiol 44: 1257–62PubMedCrossRefGoogle Scholar
  9. 9.
    Daniel T, Boineau J, Sabiston D (1971) Comparison of human ventricular activation with canine model in myocardial infarction. Circulation 44: 74–89PubMedGoogle Scholar
  10. 10.
    Denniss AR, Cody DV, Fenton SM, Richards DA, Ross DL, Russell PA, Young AA, Uther JB (1983) Significance of delayed activation potentials in survivors of myocardial infarction. J Am Coll Cardiol 1: 582 (Abstr)Google Scholar
  11. 11.
    Fontaine G, Frank R, Gallais Hamonno F, Allali I, Phan-Tuc H, Grosgogeat y (1978) Electrocardiographic des potentials tradifs du syndrome de post-excitation. Arch Mal Coeur 71: 854–64Google Scholar
  12. 12.
    Gardner PI, Ursell PC, Fenoglio JJ, Wit AL (1985) Electrophysiologic and anatomic basis for fractionated electrograms recorded from healed myocardial infarcts. Circulation 72: 596–611PubMedCrossRefGoogle Scholar
  13. 13.
    Hombach V, Höpp H-W, Braun V, Behrenbeck DW, Tauchert M, Hilger HH (1980) Die Bedeutung von Nachpotentialen innerhalb des ST-Segmentes im Oberflächen-EKG bei Patienten mit koronarer Herzkrankheit. Dtsch med Wschr 195: 1457–62CrossRefGoogle Scholar
  14. 14.
    Höpp H-W, Hombach V, Osterspey A, Deutsch H, Winter U, Behrenbeck DW, Tauchert M, Hilger HH (1985) Clinical and prognostic significance of ventricular arrhythmias and ventricular late potentials in patients with coronary heart disease. In: Hombach V, Hilger HH (eds). Holter Monitoring Technique. Technical Aspects and Clinical Applications. Schattauer, Stuttgart - New York, pp 297–307Google Scholar
  15. 15.
    Ideker RE, Mirvis DM, Smith WM (1985) Late fractionated potentials. Am J Cardiol 55: 1614–21PubMedCrossRefGoogle Scholar
  16. 16.
    Kacet, S, Libersa C, Caron J, Boudoux B, d’Haute Feuille X, Marchand J, Dagano J, Lekieffre J. The prognostic value of averaged late potentials in patients suffering from coronary artery disease. In: Aliot E, Lazzara R, eds. Ventricular Tachycardias. Martinus Nijhoff Publishers, Dortdrecht - Boston - Lancaster, in pressGoogle Scholar
  17. 17.
    Klein H, Karp RB, Kouchoukos NT, James TN, Waldo AL (1979) Ventricular mapping of abnormal myocardiun in patients with and without arrhythmias. Circulation 24, Suppl II (Abstr)Google Scholar
  18. 18.
    Kuchar D, Thorburn C, Sammel N (1985) Natural history and clinical significance of late potentials after myocardial infarction. Circulation 72, Suppl III: 477Google Scholar
  19. 19.
    Moss AJ (1980) Clinical significance of ventricular arrhythmias in patients with and without artery disease. Prog Cardiovasc Dis 23: 33–52PubMedCrossRefGoogle Scholar
  20. 20.
    Rozanski JJ, Mortara D, Myerburg RJ, Castellanos A (1981) Body surface detection of delayed depolarizations in patients with recurrent ventricular tachycardia and left ventricular aneurysm. Circulation 63: 1172–8PubMedCrossRefGoogle Scholar
  21. 21.
    Simson MB (1981) Identification of patients with ventricular tachycardia after myocardial infarction from signals in the terminal QRS complex. Circulation 64: 235–42PubMedCrossRefGoogle Scholar
  22. 22.
    Simson MB, Untereker WJ, Spielman SR, Horowitz LN, Marcus NH, Falcone RA, Harken AH, Josephson ME (1983) Relation between late potentials on the body surface and directly recorded fragmented electrocardiograms in patients with ventricular tachycardia. Am J Cardiol 51: 105PubMedCrossRefGoogle Scholar
  23. 23.
    Spielman SR, Untereker WJ, Horowitz LN, Greenspan AM, Simson MB, Kastor JA, Josephson ME (1981) Fragmented electrical activity - relationship to ventricular tachycardia. Am J Cardiol 47: 448 (Abstr)Google Scholar
  24. 24.
    Uther JB, Dennett CJ, Tan A (1978) The detection of delayed activation signals of low amplitude in the vectorcardiogram of patients with recurrent ventricular tachycardia by signal averaging. In: Sandøe E, Julian DG, Bell JW (eds) Management of ventricular tachycardia - role of mexiletine. Excerpta Medica, Amsterdam, pp 80–82Google Scholar
  25. 25.
    van Durme, JP, Pannier RH (1976) Prognostic significance of ventricular dysrhythmias 1 year after myocardial infarction. Am J Cardiol 37: 178 (Abstr)Google Scholar
  26. 26.
    Leitner ER von, Oeff M, Loock D, Jahns B, Schröder R (1983) Value of noninvasively detected delayed ventricular depolarization to predict prognosis in post myocardial infarction patients. Circulation 68, Suppl. III: 83Google Scholar
  27. 27.
    Wienerl, Mindich B, Pitchon R (1984) Endocardial activation inpatients with coronary artery disease: Effects of regional contraction abnormalties. Am Heart J 107: 1146CrossRefGoogle Scholar

Copyright information

© Dr. Dietrich Steinkopff Verlag, GmbH & Co. KG, Darmstadt 1987

Authors and Affiliations

  • G. Breithardt
    • 2
  • M. Borggrefe
    • 1
  • K. Haerten
    • 1
  • J. Schwarzmaier
    • 1
  • U. Karbenn
    • 1
  • A. Podczeck
    • 1
  1. 1.Medizinische Klinik und Poliklinik, Abteilung für Kardiologie, Pneumologie und Angiologie der Universität DüsseldorfDüsseldorfGermany
  2. 2.Medizinische Klinik und Poliklinik, Abt. für Kardiologie, Pneumologie und AngiologieUniversität DüsseldorfDüsseldorf 1Germany

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