The Use of Signal‐Averaged Electrocardiography in Predicting Patients at High Risk for Sudden Death

Delayed and inhomogeneous ventricular depolarization is found in patients with ventricular tachycardia. This abnormal activity may be discerned as a ventricular late potential (LP) by applying special signal-averaging techniques to the surface electrocardiogram. The presence of LPs after acute myocardial infarction (AMI) is associated with an increased risk of serious ventricular arrhythmias and sudden cardiac death during the subsequent year. Thus the signal-averaged ECG (SAECG) can identify a high risk subset of patients following AMI for whom more intensive diagnostic and/or therapeutic measures are indicated. Patients with findings ordinarily indicative of a relatively poor prognosis, such as reduced left ventricular ejection fraction, may be more precisely classified into high or low risk based on the presence or absence of LPs. The SAECG may be helpful in selecting patients with other types of presentations, such as syncope, who are likely to benefit from electrophysiological testing.