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Analyse von QRST-Integral und QT-Dispersion mittels „Body surface potential mapping” bei Patienten mit malignen ventrikulären Arrhythmien

Analysis of QRST integral and QT dispersion by body surface potential mapping in patients with malignant ventricular arrhythmias

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Zusammenfassung

Bei 74 Patienen wurde in einer retrospektiven Analyse der Wert des „Body surface potential mapping” (BSPM) im Vergleich zum 12-Kanal-EKG zur Erfassung von Repolarisationsstörungen bei Patienten mit koronarer Herzkrankheit und ohne kardiale Grunderkrankung untersucht. Bei Patienten mit idiopathischem Kammerflimmern (n=13) war sowohl die Anzahl von Extrema im QRST-Integralmap signifikant höher als in der Kontrollgruppe (n=18; 3,15±0,99 gegen 2,17±0,51, p<0,001) als auch die QT-Dispersion signifikant größer (0,10±0,03 gegen 0,07±0,01, p<0,001) Mittels QT-Dispersion im 12-Kanal-EKG war kein Unterschied zwischen beiden Gruppen nachweisbar. Bei Patienten mit koronarer Herzerkrankung (KHK) waren die Anzahl Extrema im QRST-Integralmap und QT-Dispersion ebenfalls höher als in der Kontrollgruppe, es fanden sich jedoch keine signifikanten Unterschiede zwischen den Patienten mit plötzlichem Herztod (n=22) und ohne stattgehabte, maligne, ventrikuläre Arrhythmie (n=21).

Das BSPM erfaßt Störungen der Repolarisation mit größerer Sensitivität als das 12-Kanal-EKG und erfaßt somit eine mögliche Ursache lebensbedrohlicher Arrhythmien bei Patienten ohne kardiale Grunderkrankung. Ein eventueller Nutzen zur Risikoerkennung bei Patienten mit KHK muß noch gezeigt werden.

Summary

In a retrospective analysis in 74 patients with coronary artery disease or no obvious heart disease, the value of “body surface potential mapping” for the identification of repolarization abnormalities was investigated compared to the standard 12-lead ECG. In patients with idiopathic ventricular fibrillation the number of extrema in the QRST integral map was significantly higher than in the control group (3.15±0.99 vs. 2.17±0.51, p<0.001) and the QT dispersion was also higher (0.10±0.03 vs. 0.07±0.01, p<0.001), whereas there was no difference between either group in the 12-lead ECG QT dispersion. In patients with coronary artery disease the number of extrema in the QRST integral map and QT dispersion were also higher compared to the control group, but there were no significant differences between patients with or without aborted sudden cardiac death.

In conclusion, BSPM identifies repolarization abnormalities not detected by 12-lead ECG, thereby identifying a potential reason for cardiac arrest in patients without overt heart disease. The usefulness of this technique for risk stratification in patients with coronary artery disease remains to be elucidated.

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Authors and Affiliations

  1. Medizinische Klinik I der RWTH Aachen, Pauwelstraße 30, 52057, Aachen

    C. Stellbrink, E. Stegemann, K. Mischke, H. Schütt & P. Hanrath

  2. Medizinische Technik, Siemens AG, Henkestraße 127, 91052, Erlangen

    R. Killmann

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  1. C. Stellbrink
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  2. E. Stegemann
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  3. R. Killmann
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  4. K. Mischke
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  5. H. Schütt
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  6. P. Hanrath
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Stellbrink, C., Stegemann, E., Killmann, R. et al. Analyse von QRST-Integral und QT-Dispersion mittels „Body surface potential mapping” bei Patienten mit malignen ventrikulären Arrhythmien. Herzschr Elektrophys 8, 107–112 (1997). https://doi.org/10.1007/BF03042497

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  • DOI: https://doi.org/10.1007/BF03042497

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