Hypertensive Heart Disease and Endocardially Recorded Late Potentials

Thirteen patients with compensated (group 1) and six patients with decompensated hypertensive heart disease (group 2) were examined for ventricular late potentials using endocardial recording techniques. With endocardial catheter mapping, left ventricular late potentials could be recorded in six patients in group 2 (100%) but only in one patient from group 1 (8%); right ventricular late potentials could not be recorded in group 1 or in group 2 patients. The amplitudes of the late potentials were always in the microvolt range, with values ranging between 170 and 620 μV (with a mean of 349 ± 152 μV). The coupling intervals of the late potentials—measured from the beginning of the preceding QRS complex to the beginning of the late potential—were found to be between 110 and 440 ms (with a mean of 311 ± 122 ms). Late potentials could only be recorded in patients with reduced left ventricular pumping function—i.e., patients with an ejection fraction of <62% and a cardiac index of ≤2.9 L/min/m2, whereas patients with normal hemodynamic parameters had normal endocardial electrograms. Ventricular arrhythmias were recorded during 24-h, long-term electrocardiogram (ECG) in all patients in group 2 (100%) and in five patients from group 1 (38%). Ryan's class 2–4b malignant ventricular arrhythmias were only found in patients with demonstrable ventricular late potentials and reduced left ventricular pumping function. The present study shows that ventricular late potentials, and thus also ventricular arrhythmias, are found almost exclusively in patients with decompensated hypertensive heart disease. However, the prognostic value of ventricular late potentials for this disease must be tested further with a larger group of patients.