Skip to main content
SpringerLink
Log in

Einfluß einer perkutanen transluminalen Koronarangioplastie auf die Ausprägung ventrikulärer Spätpotentiale bei Patienten mit abgelaufenem Myokardinfarkt

Impact of a percutaneous transluminal coronary angioplasty on the prevalence of ventricular late potentials among patients with survived myocardial infarction

  • Published:
Herzschrittmachertherapie und Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Ziel der Untersuchung war, herauszufinden, ob auch in der chronischen Infarktphase eine kausale antiischämische Intervention i. S. einer perkutanen transluminalen Koronarangioplastie (PTCA) zur einer Reduktion ventrikulärer Spätpotentiale führt. Bei 24 Patienten wurden im Abstand von 6,0±4,2 Monaten (Gruppe A, mit PTCA) bzw. von 6,2±5,2 Monaten (Gruppe B, konservative Therapie) Messungen des signalgemittelten EKG zur Analyse ventrikulärer Spätpotentiale (LP) durchgeführt. Alle Patienten hatten einen abgelaufenen Myokardinfarkt in der Vorgeschichte. Spätpotentiale galten als positiv, wenn mindestens zwei Kriterien positiv waren. Im Gesamtkollektiv wiesen 73% der Patienten positive Spätpotentiale auf. In Gruppe A wurde binnen eines monats nach initialer Spätpotentialmessung die PTCA durchgeführt. Danach kam es zu einer signifikanten Abnahme LP-positiver Patienten (von 64% auf 18%), während in Gruppe B die Anzahl LP-positiver Patienten nur tendenziell abnahm (85% vs. 62%). Auch die signalgemittelten Einzelkriterien veränderten sich in Gruppe A z. T. signifikant (QRS 113,04±13,65 vs. 100,55±6,97 ms; p<0.01, RMS 24,05±24,13 vs. 35,39±16,89 μV; n.s., LAS 41,23±13,27 vs. 29,68±6,47 ms; p<0.05). In Gruppe B kam es zu keinen signifikanten Veränderungen.

Zusammenfassend zeigen diese Ergebnisse, daß auch in der chronischen Postinfarktphase eine PTCA des Infarktgefäßes bei stenosierender KHK zu einer Reduktion von ventrikulären Spätpotentialen führen kann. Ob dadurch auch die Prognose der Patienten verbessert wird, müssen zukünftige Untersuchungen zeigen.

Summary

The aim of the study was to evaluate whether a causal antiischemic intervention as percutaneous transluminal coronary angioplasty (PTCA) leads to a reduction of ventricular late potentials in the chronic post myocardial infarction period. In 24 patients, signal-averaged electrocardiograms (SAECG) for two groups were recorded for the analysis of ventricular late potentials (LP) before and after 6.0±4.2 months (group A, with PTCA) and 6.2±5.2 months, respectively (group B, conservative therapy). All patients presented prior myocardial infarction. LP were defined present if two of the three time domain criteria were met. In the whole study group, LP were positive in 73%. In group A, a PTCA was performed one month after the initial SAECG measurement. In group A, the presence of ventricular late potentials was significantly reduced (64% vs. 18%), whereas in group B only a slight decline of late potentials could be observed (85% vs. 62%). The parameters of the signal averaged ECG varied significantly in group A before and after PTCA (QRS 113.04±13.65 vs. 100.55±6.97 ms (p<0.05), RMS 24.04±24.13 vs. 35.39±16.89 μV (p=n.s.), LAS 41.23±13.27 vs. 29.68±6.47 ms (p<0.05)). The results in group B were not altered significantly.

In conclusion, these results show that a PTCA of the infarct-related artery can lead to a reduction in ventricular late potentials in patients with significant coronary artery disease, who are also in the chronic post myocardial infarction period. Whether it is possible to improve the prognosis of these patients has also to be shown in future studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abboud S, Belhassen B, Laniado S, Sadeh D (1983) Noninvasive recording of late ventricular activity using an advanced method in patients with a damaged mass of ventricular tissue. J Electrocardiol 16:245–252

    Article  PubMed  CAS  Google Scholar 

  2. Boehrer JD, Glamann DB, Lange RA, Willard JE, Brogan WC, Eichhorn EJ, Grayburn PA, Anwar A, Hillis ID (1992) Effect of coronary angioplasty on late potentials one to two weeks after acute myocardial infarction. Am J Cardiol 70:1515–1519

    Article  PubMed  CAS  Google Scholar 

  3. Breithardt G, Becker R, Seipel L, Abendroth RR, Ostermeyer J (1981) Noninvasive detection of late potentials in man—a new marker for ventricular tachycardia. Eur Heart J 2:1–11

    PubMed  CAS  Google Scholar 

  4. Breithardt G, Borggrefe M, Karbenn U, Ostermeyer J, Abendroth RR, Yeh HL, Seipel L (1982) Verhalten ventrikulärer Spätpotentiale nach operativer Therapie ventrikulärer Tachykardien. Z Kardiol 71:381–386

    PubMed  CAS  Google Scholar 

  5. Breithardt G, Borggrefe M (1986) Pathophysiological mechanism and clinical significance of ventricular late potentials. Eur Heart J 7:364–385

    PubMed  CAS  Google Scholar 

  6. Breithardt G, Cain ME, El-Sherif N, Flowers N, Hombach V, Janse M, Simson MB, Steinbeck G (1991) Standards for analysis of ventricular late potentials using high resolution or signal-averaged electrocardiography. A statement by a Task Force Committee between the European Society of Cardiology, the American Heart Association and the American College of Cardiology, Eur Heart J 12:473–480

    PubMed  CAS  Google Scholar 

  7. Breithardt G, Seipel L, Ostermeyer J, Karbenn U, Abendroth RR, Borggrefe M, Yeh HL, Bircks W (1982) Effects of antiarrhythmic surgery on late ventricular potentials recorded by precordial signal—averaging in patients with ventricular tachycardia. Am Heart J 104:996–1003

    Article  PubMed  CAS  Google Scholar 

  8. Caref EB, Goldberg N, Mendelson L, Hanley G, Okereke R, Stein RA, El-Sherif N (1990) Effects of exercise on the signal-averaged electrocardiogram in coronary artery disease. Am J Cardiol 66:54–58

    Article  PubMed  CAS  Google Scholar 

  9. Carn B, Pedretti R, Bonelli R, Etro MD, Laporta A, Gementi A, Lasucci R (1992) Late arrhythmic events and patency of the infarct related coronary artery in survivors of acute myocardial infarction. Rev Port Cardiol 11:817–821

    Google Scholar 

  10. De Chillou C, Sadoul N, Brunotte F, Pichene M, Aliot E (1991) Effet de la fibrinolyse sur les potentiels tardifs dans l’infarctus myocardique. Ann Cardiol Angiol Paris 40:75–79

    Google Scholar 

  11. Denereaz D, Zimmermann M, Adamec R (1992) Significance of ventricular late potentials in non-ischemic dilated cardiomyopathy. Eur Heart J 13:895–901

    PubMed  CAS  Google Scholar 

  12. Denniss AR, Johnson DC, Richards DA, Ross DL, Uther JB (1987) Effect of excision of ventricular myocardium on delayed potentials detected by the signalaveraged electrocardiogram in patients with ventricular tachycardia. Am J Cardiol 59:591–595

    Article  PubMed  CAS  Google Scholar 

  13. Farrell ThG, Bashir Y, Cripps T, Malik M, Poloniecki J, Bennett D, Ward D, Camm AJ (1991) Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol 18:687–697

    PubMed  CAS  Google Scholar 

  14. Goedel-Meinen L, Hofmann M, Schmidt G, Maier-Rudolph W, Barthel P, Schrag A, Baedeker W, Blömer H (1991) Einfluß von Amiodaron auf Signalmittelungs-und Langzeit EKG. Z Kardiol 80:187–193

    PubMed  CAS  Google Scholar 

  15. Gomes JA, Mehra R, Barreca P, El-Sherif N, Hariman R, Holthman R (1985) Quantitative analysis of the high frequency components of the signal averaged QRS complex in patients with acute myocardial infarction: a prospective study. Circulation 72:105–111

    PubMed  CAS  Google Scholar 

  16. Gomes JA, Winters SL, Ergin A, Machac J, Estioko M, Alexopoulous D, Pe E (1991) Clinical and electrophysiologic determinants, treatment and survival of patients with sustained malignant ventricular tachyarrhythmias occurring late after myocardial infarction. J Am Coll Cardiol 17:320–326

    PubMed  CAS  Google Scholar 

  17. Gomes JA, Winters SL, Logic JR, Sheffield LT, Kansal S, Roitman DI (1989) The prognostic significance of quantitative signal-averaged variables relative to clinical variables, site of myocardial infarction, ejection fraction and ventricular premature beats: a prospective study. J Am Coll Cardiol 13:377–384

    PubMed  CAS  Google Scholar 

  18. Hennersdorf M, Ivens K, Heering P, Schoebel FC, Vester EG, Strauer BE (1995) The reproducibility of ventricular late potentials in hemodialysis patients. PACE 18, 5:II-1110

    Google Scholar 

  19. Hennersdorf M, Perings Ch, Vester EG, Strauer BE (1996) Ventrikuläre Spätpotentiale und ihre Beziehung zu ischämisch ausgelösten Tachyarrhythmien. Z Kardiol Suppl 1:74

    Google Scholar 

  20. Hennersdorf M, Stark P, Vester EG, Strauer BE (1995) The hemodynamic and electrophysiologic effects of celiprolol in patients with ischemic and nonischemic cardiomyopathy. Eur Heart J 16, Suppl 1:158

    Google Scholar 

  21. Keeling PJ, Kulakowski P, Yi G, Slade AKB, Bent SE, McKenna WJ (1993) Usefulness of signal-averaged electrocardiogram in idiopathic dilated cardiomyopathy for identifying patients with ventricular arrhythmias. Am J Cardiol 72:78–84

    Article  PubMed  CAS  Google Scholar 

  22. Klein H, Trappe HJ, Schröder E (1988) Pathophysiologische Grundlagen ventrikulärer Spätpotentiale. Herz 13:137–146

    PubMed  CAS  Google Scholar 

  23. Kuchar DL, Thorburn CW, Sammel NL (1987) Prediction of serious arrhythmic events after myocardial infarction: signal-averaged electrocardiogram. Holter monitoring and radionuclide ventriculography. J Am Coll Cardiol 9:531

    PubMed  CAS  Google Scholar 

  24. Kuchar DL, Thorburn NL, Sammel NL (1986) Late potentials detected after myocardial infarction: natural history and prognostic significance. Circulation 74:1280–1289

    PubMed  CAS  Google Scholar 

  25. Mancini D, Wong KL, Simson MB (1993) Prognostic value of an abnormal signal-averaged electrocardiogram in patients with nonischemic congestive cardiomyopathy. Circulation 87:1083–1092

    PubMed  CAS  Google Scholar 

  26. Middlekauff HR, Stevenson WG, Woo MA, Moser DK, Stevenson LW (1990) Comparison of frequency of late potentials in idiopathic dilated cardiomyopathy and ischemic cardiomyopathy with advanced congestive heart failure and their usefulness in predicting sudden death. Am J Cardiol 66:1113–1117

    Article  PubMed  CAS  Google Scholar 

  27. Portratz J, Djondagic H, Wege G, Diederich KW (1983) Rechtsventrikuläre intrakardiale Aufzeichnungen von Spätpotentialen bei Patienten mit akutem Herzinfarkt und rezidivierenden Kammertachykardien. Z Kardiol 72:609–616

    Google Scholar 

  28. Rubin D, Sorbera C, Cook J, McAllister A, Burke R, Weiss MB (1992) Reversible late potentials due to ischemia. PACE, Vol 15:2250–2254

    PubMed  CAS  Google Scholar 

  29. Seifert Th, Borggrefe M, Karbenn U, Martinez-Rubio A, Breithardt G (1989) Verhalten ventrikulärer Spätpotentiale nach Katheterablation ventrikulärer Tachykardien. Z Kardiol 78:647–653

    PubMed  CAS  Google Scholar 

  30. Simson MB (1981) Identification of patients with ventricular tachycardia after myocardial infarction from signals in the terminal QRS complex. Circulation 69:235–242

    Google Scholar 

  31. Simson MB (1981) Use of signals in the terminal QRS-complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation 64:235–242

    PubMed  CAS  Google Scholar 

  32. Steinberg JS, Hochman JS, Morgan ChD, Dorian P, Naylor D, Theroux P, Topol EJ, Armstrong PW, the LATE Ancillary Study Investigators (1994) Effects of thrombolytic therapy administered 6 to 24 hours after myocardial infarction on the signal-averaged ECG. Results of a multicenter randomized trial. Circulation 90:746–752

    PubMed  CAS  Google Scholar 

  33. Turitto G, Caref EB, Zanchi E, Menghini F, Kelen G, El-Sherif N (1991) Spontaneous myocardial ischemia and the signal-averaged electrocardiogram. Am J Cardiol 67:676–680

    Article  PubMed  CAS  Google Scholar 

  34. Turitto G, Zanchi E, Risa AL, Maddaluna A, Saltarocchi ML, Vajola SF, Prati PL (1990) Lack of correlation between transient myocardial ischemia and late potentials on the signal-averaged electrocardiogram. Am J Cardiol 65:290–296

    Article  PubMed  CAS  Google Scholar 

  35. Vatterott PJ, Hammill SC, Bailey KR, Wiltgen ChM, Gersh BJ (1991) Late potentials on signal-averaged electrocardiogram and patency of the infarct-related artery in survivors of acute myocardial infarction. J Am Coll Cardiol 17:330–337

    Article  PubMed  CAS  Google Scholar 

  36. Vester EG, Emschermann C, Stobbe U, Ochiulet-Vester J, Perings C, Kühl U, Schultheiss HP, Pölitz B, Heydthausen M, Strauer BE (1994) Late potentials and heart rate variability in heart muscle disease. Eur Heart J 15 (Suppl C):25–33

    PubMed  Google Scholar 

  37. Vester EG, Ganschow U, Schoebel FC, Reinhardt M, Müller-Gärtner HW, Strauer BE (1994) Regional mismatch between glucose-metabolism and perfusion in the myocardium of patients with ventricular tachycardia. Circulation 90 (4,2):I-314

    Google Scholar 

  38. Vester EG, Perings C, Kuhls S, Ochiulet-Vester J, Strauer BE (1995) Myokardiale Laktatextraktion während programmierter Ventrikelstimulation und ihre Bedeutung für die Kausaltherapie ischämisch induzierter ventrikulärer Tachyarrhythmien. Z Kardiol 84:443–458

    PubMed  CAS  Google Scholar 

  39. Vester EG, Strauer BE (1994) Epidemiologie des plötzlichen Herztodes. Herzschr Elektrophys 5, Supplement 1:6–18

    Google Scholar 

  40. Vester EG, Strauer BE (1994) Ventricular late potentials: state of the art and future perspectives. Eur Heart J 15 (Suppl C):34–48

    PubMed  Google Scholar 

  41. Vester EG, Strauer BE (1994) Patienten mit malignen Arrhythmien: Verbesserung der Prognose durch Revaskularisation? Herzschr Elektrophys 6, Suppl 1:29–41

    Google Scholar 

  42. Zimmermann M, Adamec R, Ciaroni S, Malbois F, Tieche R (1991) Reduction in the frequency of ventricular late potentials after acute myocardial infarction by early thrombolytic therapy. Am J Cardiol 67:697–703

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik B, Klinik für Kardiologie Pulmologie und Angiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf

    M. Hennersdorf, Ch. Perings, F. C. Schoebel, E. G. Vester & B. E. Strauer

Authors
  1. M. Hennersdorf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ch. Perings
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. C. Schoebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. G. Vester
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. E. Strauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hennersdorf, M., Perings, C., Schoebel, F.C. et al. Einfluß einer perkutanen transluminalen Koronarangioplastie auf die Ausprägung ventrikulärer Spätpotentiale bei Patienten mit abgelaufenem Myokardinfarkt. Herzschr Elektrophys 8, 205–212 (1997). https://doi.org/10.1007/BF03042403

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03042403

Schlüsselwörter

Key words

Search

Navigation