Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction

Abstract

Small, high-frequency electrocardiographic signals were recorded from the body surface in 39 patients with and 27 patients without ventricular tachycardia (VT). All patients were in normal sinus rhythm, had a previous myocardial infarction, were not taking antiarrhythmic drugs, and did not have bundle branch block. Bipolar X, Y, Z leads were signal averaged and processed by a bidirectional digital filter that allowed low-amplitude signals to be detected in the terminal QRS complex and ST segment. The high-pass filter frequency was 25 Hz. Patients with VT had a lower amplitude of high-frequency signal in the late QRS complex. In the last 40 msec of the filtered QRS complex, the patients with VT had 14.9 ± 14.4 μV of high-frequency signal; patients without VT had 73.8 ± 47.7 μV (p < 0.0001). 92% of the patients with VT had less than 25 μV of high-frequency voltage; only 7% of patients without VT had less than 25 μV (p < 0.0001). Patients with VT had a longer QRS duration than those without VT, 139 ± 26 vs 95 ± 10 msec (p < 0.0001). The QRS duration was longer than 120 msec in 72% of the patients with VT but in none of the patients without VT (p < 0.0001). In all patients there was no separate and discrete high-frequency signal in the ST segment. Advanced signal processing of the ECG accurately identified the patients in the study with VT after myocardial infarction.