Skip to main content
SpringerLink
Log in

Clinical significance of high resolution electrocardiography — sinus node, His bundle and ventricular late potentials

  • Chapter
Signal Averaged Electrocardiography

Abstract

Electrical events of the heart can be detected by the conventional surface ECG, however, only depolarization and recovery of the atria and ventricles and the atrio-ventricular conduction delay (P-Q interval) are reflected by the corresponding signals, the P wave and the QRS complex. The activity of the sinus node itself and the His-Purkinje system is buried within the baseline noise because on the body surface their amplitudes are only in the microvolt range. Prolongation of intraventricular conduction of larger myocardial areas can be discovered by the typical hemiblock or bundle branch block patterns of ventricular de- and repolarization, whereas delayed activation of smaller areas of ventricular myocardium, e.g. in the neighborhood of an infarcted area or in right ventricular dysplasia, will be invisible within the conventional surface ECG due to the small amplitude (microvolt level) of the signals of interest1.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. El-Sherif N, Restivo M, Craelius W, et al. High resolution electrocardiography — Basic and clinical aspects. In: Hombach V, Hilger HH, Kennedy HL, editors. Electrocardiography and Cardiac Drug Therapy. Dordrecht: Kluwer Academic Publishers; 1985:172–203.

    Google Scholar 

  2. Josephson ME, Horowitz LN, Spielman SR, Greenspan AM, Van de Pol C, Harken AH. Comparison of endocardial catheter mapping with intraoperative mapping of ventricular tachycardia. Circulation. 1980;61:395–404.

    Article  PubMed  CAS  Google Scholar 

  3. Berbari EJ, Lazzara R, Samet P, Scherlag BJ. Noninvasive technique for detection of electrical activity during the P-R segment. Circulation. 1973;48:1005–13.

    Article  PubMed  CAS  Google Scholar 

  4. Stopczyk MJ, Kopec J, Zochowski RJ, Pieniak M. Surface recording of electrical heart activity during the P-R segment in man by a computer averaging technique (abstract). Int Res Commun Syst. 1973;11:21–2.

    Google Scholar 

  5. Flowers NC, Horan LG. His bundle and bundle branch recordings from the body surface (abstract). Circulation. 1973;48:IV–102.

    Google Scholar 

  6. Braun V, Hombach V, Höpp HW, Scholl H, Gil-Sanchez D, Hilger HH. Preatrial activity recorded from intracardiac and surface leads by signal averaging. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer Verlag; 1981:81–94.

    Google Scholar 

  7. Hombach V, Höpp H, Braun V, Behrenbeck DW, Hilger HH. Pre-P potentials in the conventional body surface ECG. Dtsch Med Wochenschr. 1981;106:771–9.

    Article  PubMed  CAS  Google Scholar 

  8. Mackintosh AF, English MJ, Vincent R, Woollons DJ, Chamberlain DA. Low-voltage electrical activity preceding right atrial depolarization in man. Br Heart J. 1978;42:117–23.

    Article  Google Scholar 

  9. Wajszczuk WJ, Palko T, Przybylski J, Stopczyk MJ, Bauld TJ, Rubenfire M. External recording of sinus node region activity in animals and in man. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer Publishers; 1981:65–79.

    Google Scholar 

  10. Hishimoto Y, Sawayama T. Non-invasive recording of His bundle potentials in man — simplified method. Br Heart J. 1975;37:635–7.

    Article  PubMed  CAS  Google Scholar 

  11. Furness A, Sharratt GP, Carson P. The feasibility of detecting His-bundle activity from body surface. Cardiovasc Res. 1975;9:390–6.

    Article  PubMed  CAS  Google Scholar 

  12. Van den Akker TJ, Goovaerts HG, Schneider H. Real time method for noninvasive recording of His bundle activity of the electrocardiogram. Comp Biomed Res. 1976;9:559–69.

    Article  Google Scholar 

  13. Vincent R, Stroud NP, Jenner R, English MJ, Woollons DJ, Chamberlain DJ. Noninvasive recording of electrical activity in the PR segment in man. Br Heart J. 1978;40:124–30.

    Article  PubMed  CAS  Google Scholar 

  14. Fontaine G, Guiraudon G, Frank R. Intramyocardial conduction defects in patients prone to ventricular tachycardia. III. The post-excitation syndrome and ventricular tachycardia. In: Sandoe E, Julian DG, Bell JW, editors. Management of Ventricular Tachycardia — Role of Mexiletine. Amsterdam: Excerpta Medica; 1978:67–9.

    Google Scholar 

  15. Uther JB, Dennett CJ, Tan A. The detection of delayed activation signals of low amplitude in the vectorcardiogram of patients with recurrent ventricular tachycardia by signal averaging. In: Sandow E, Julian DG, Bell JW, editors. Management of Ventricular Tachycardia — Role of Mexiletine, Amsterdam: Excerpta Medica. 1978:80–2.

    Google Scholar 

  16. Hombach V, Höpp HW, Braun V, Behrenbeck DW, laudiert M, Hilger HH. Significance of post-excitation potentials within the ST segment in the surface ECG of patients with coronary heart disease. Dtsch Med Wochenschr. 1980;105:1457–62.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  18. Simson MB. Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation. 1981;64:235–42.

    Article  PubMed  CAS  Google Scholar 

  19. Hombach V, Kebbel U, Höpp HW, et al. Continuous registration of micropotentials of the human heart: preliminary results with a new high resolution ECG amplifier system. Dtsch Med Wochenschr. 1982;107:1951–6.

    Article  PubMed  CAS  Google Scholar 

  20. Bonke FIM. Electrophysiology of the sinus node. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer Publishers; 1981:23–32.

    Google Scholar 

  21. Steinbeck G, Haberl R, Lüderitz B, Allessie A, Bonke FIM, Lammers WJEP. Comparison of true and calculated sinoatrial conduction time by atrial pacing in the isolated rabbit heart. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:33–9.

    Google Scholar 

  22. Stopczyk MJ, Pieniak M, Wajszczuk W, Rubenfire M. Sinus node activity in man and animal studies recorded intraatrially by an on-line pre-memorized averaging technique. In: Proceedings of the 5th International Symposium on Cardiac Pacing, Amsterdam: Excerpta Medica International Congress Series, 1976, No. 375: 13–18.

    Google Scholar 

  23. Gebhardt-Seehausen U, Bethge C, Bonke FIM, Merx W. Continuous recordings of sinus nodal potentials. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:41–52.

    Google Scholar 

  24. Hombach V, Zanker R, Behrenbeck DW, Hilger HH. Recording of sinus node potentials in man. Z Kardiol. 1978;67:155–62.

    PubMed  CAS  Google Scholar 

  25. Hombach V, Gil-Sanchez D, Zanker R, Behrenbeck DW, Tauchert M, Hilger HH. An approach to direct detection of sinus nodal activity in man. J Electrocardiol. 1979;12:343–51.

    Article  PubMed  CAS  Google Scholar 

  26. Hombach V, Braun V, Höpp HW, et al. The applicability of the signal averaging technique in clinical cardiology. Clin Cardiol. 1982;5:107–24.

    Article  PubMed  CAS  Google Scholar 

  27. Hombach V, Hilger HH, Braun V, Höpp HW. The significance of the signal averaging technique in cardiology. Klin Wochenschr. 1982;60:379–91.

    Article  PubMed  CAS  Google Scholar 

  28. Hombach V, Braun V, Höpp HW, Behrenbeck DW, Tauchert M, Hilger HH. Noninvasive detection of potentials of the bundle of His from body surface. Münch Med Wochenschr. 1981;123:173–6.

    CAS  Google Scholar 

  29. Tournoux B, Poindessault JP, Gargouil YM, Barraine R, Rousseau G. Intéretet limites de l’enregistrement des potentiels du fasceau de His par voie externe chez l’homme. Ann Cardiol Angiol. 1980;29:327–32.

    CAS  Google Scholar 

  30. Wajszczuk WJ, Stopczyk MJ, Moskowitz MS, et al. Noninvasive recording of His-Purkinje activity in man by QRS-triggered signal averaging. Circulation. 1978;58:95–101.

    Article  PubMed  CAS  Google Scholar 

  31. Tonkin AM, Blood RJ, Riggs AR, Bennett A, Heddle WF, Helfgott A. Non-invasive recording of His bundle potentials: limitations of existing signal averaging techniques. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology, Stuttgart-New York: Schattauer-Publishers, 1981:291–9.

    Google Scholar 

  32. McKenna WJ, Rowland E, Mortara D, Borggrefe M, Krikler DM. Non-invasive recording of the His bundle electrogram: evaluation of the Marquette high resolution MAC unit. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology, Stuttgart-New York: Schattauer-Publishers, 1981:301–10.

    Google Scholar 

  33. Pernod J, Court L, Duret JC, Proust F, Droniou J. Possibilité de détection des potentiels hisiens ã· partir d’electrodes thoraciques de surface. Nouv Presse Med. 1977;6:2963–8.

    PubMed  CAS  Google Scholar 

  34. Vincent R, English MJ, Woulloons DJ, et al. Surface His bundle potentials and other low amplitude cardiac signals by signal averaging. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:351–62.

    Google Scholar 

  35. Takeda H, Kitamura K, Takanashi T, et al. Noninvasive recording of His-Purkinje activity in patients with complete atrioventricular block. Circulation. 1979;60:421–6.

    Article  PubMed  CAS  Google Scholar 

  36. Takeda H, Kitamura K, Tsujimura T, Takanashi T, Hamamoto H. Non-invasive localization of A-V block by an ‘automated discrimination circuit’. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:311–27.

    Google Scholar 

  37. Stopczyk MJ, Walczak F, Kepski R, Plucinsky Z, Peczalski K. The history of noninvasive His-bundle recording: from averaging to continuous record. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:283–9.

    Google Scholar 

  38. El-Sherif N, Mehra R, Gomes JAC, Kelen G. Appraisal of a low noise electrocardiogram. J Am Coll Cardiol. 1983;1:456–62.

    Article  PubMed  CAS  Google Scholar 

  39. Hombach V, Kebbel U, Höpp HW, Winter UJ, Hirche H. Non-invasive beat-by-beat registration of ventricular late potentials using high resolution electrocardiography. Int J Cardiol. 1984;6:167–83.

    Article  PubMed  CAS  Google Scholar 

  40. Flowers NC, Simson MB, Wylds AC, Yang W, Horan LG. Surface recognition of His-Purkinje activity on an every beat basis. In: El-Sherif N, Turitto G, editors. High-Resolution Electrocardiography. New York: Futura Publishing Company; 1992:243–58.

    Google Scholar 

  41. Hombach V, Eggeling T, Höher M, et al. Methods for detection of ventricular late potentials-high-amplification ECG, signal-averaged technique, frequency analysis, intracardiac mapping. Herz. 1988;13:147–59.

    PubMed  CAS  Google Scholar 

  42. Durrer D, Van Lier A, Buller J. Epicardial and intramural excitation in chronic myocardial infarction. Am Heart J. 1964;68:765–9.

    Article  PubMed  CAS  Google Scholar 

  43. Berbari EJ, Scherlag BJ, Hope R, Lazzara R. Recording from the body surface of arrhythmogenic ventricular activity during the ST segment. Am J Cardiol. 1978;41:697–702.

    Article  PubMed  CAS  Google Scholar 

  44. El-Sherif N, Gomes J, Restivo M, Mehra R. Late potentials and arrhythmogenesis. PACE. 1985;8:440–50.

    Article  PubMed  CAS  Google Scholar 

  45. Boineau JP, Cox JL. Slow ventricular activation in acute myocardial infarction. A source of reentrant premature ventricular contractions. Circulation. 1973;48:702–7.

    Article  PubMed  CAS  Google Scholar 

  46. Turitto G, Zanchi E, Risa AL, et al. Lack of correlation between transient myocardial ischemia and late potentials on the signal-averaged electrocardiogram. Am J Cardiol. 1990;65:290–7.

    Article  PubMed  CAS  Google Scholar 

  47. Hombach V, Ost W, Clausen M, et al. Advanced methods for assessing symptomatic or silent myocardial ischemia. Isr J Med Sci. 1989;25:527–32.

    PubMed  CAS  Google Scholar 

  48. Hombach V, Clausen M, Osterhues HH, et al. Methodological aspects of detecting patients with symptomatic and silent myocardial ischemia. In: Kellermann JJ, Braunwald E, editors. Silent Myocardial Ischemia - A Critical Appraisal. Basel-New York: Karger-Publishers; 1990:76–95.

    Google Scholar 

  49. Caref EB, Goldberg N, Mendelson L, et al. Effects of exercise on the signal-averaged electrocardiogram in coronary artery disease. Am J Cardiol. 1990;66:54–61.

    Article  PubMed  CAS  Google Scholar 

  50. Gang ES, Lew AS, Hong M, Wang FZ, Siebert CA, Peter T. Decreased incidence of ventricular late potentials after successful thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1989;321:712–7.

    Article  PubMed  CAS  Google Scholar 

  51. Turitto G, Risa AL, Zanchi E, Prati PL. The signal-averaged electrocardiogram and ventricular arrhythmias after thrombolysis for acute myocardial infarction. J Am Coll Cardiol. 1990;15:1270–6.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  53. Brune S, Tebbe U, Wojcik J, Gonska BD, Kreuzer H. Effect of thrombolytic therapy for acute myocardial infarction on the incidence of ventricular late potentials. Z Kardiol. 1991;80:344–7.

    PubMed  CAS  Google Scholar 

  54. Pedretti R, Laporta A, Etro MD, et al. Influence of thrombolysis on signal-averaged electrocardiogram and late arrhythmic events after acute myocardial infarction. Am J Cardiol. 1992;69:866–72.

    Article  PubMed  CAS  Google Scholar 

  55. Breithardt G, Borggrefe M, Karbenn U. Prevalence of late potentials in patients with and without ventricular tachycardia: Correlation with angiographic findings. Am J Cardiol. 1982;49:1932–9.

    Article  PubMed  CAS  Google Scholar 

  56. Denes P, Santarelli P, Hauser RG, Uretz EF. Quantitative analysis of the high frequency components of the terminal portion of the body surface QRS in normal subjects and in patients with ventricular tachycardia. Circulation. 1983;67:1129–34.

    Article  PubMed  CAS  Google Scholar 

  57. Poll DS, Marchlinski FE, Falcone RA, Simson MB. Abnormal signal averaged ECG in nonischemic congestive cardiomyopathy: relationship to sustained ventricular tachyarrhythmias (abstr). Circulation. 1984;70:II,253.

    Google Scholar 

  58. Kuchar DL, Thorburn CW, Sammel NL. Late potentials detected after myocardial infarction: natural history and prognostic significance. Circulation. 1986;74:1280–7.

    Article  PubMed  CAS  Google Scholar 

  59. Worley SJ, Mark DB, Smith WM, et al. Comparison of time domain and frequency domain variables using multivariable analysis. J Am Coll Cardiol. 1988;11:1041–7.

    Article  PubMed  CAS  Google Scholar 

  60. Osterspey A, Höpp HW, Hombach V, et al. Diagnostic and prognostic significance of ventricular late potentials in patients with coronary heart disease. In: Steinbach K, editor. Cardiac Pacing. Darmstadt: Steinkopff-Verlag; 1983:663–70.

    Chapter  Google Scholar 

  61. Von Leitner ER, Oeff M, Loock D, Jahns B, Schröder R. Value of noninvasively detected delayed ventricular depolarizations to predict prognosis in post myocardial infarction patients. (abstr) Circulation. 1983;68:III,83.

    Google Scholar 

  62. Breithardt G, Borggrefe M. Pathophysiological mechanisms and clinical significance of ventricular late potentials. Eur Heart J. 1986;7:364–76.

    PubMed  CAS  Google Scholar 

  63. Denniss AR, Richards DA, Cody DV, et al. Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiograms of survivors of acute myocardial infarction. Circulation. 1986;74:731–7.

    Article  PubMed  CAS  Google Scholar 

  64. Denniss AR, Richards DA, Cody DV, et al. Correlation between signal-averaged electrocardiogram and programmed stimulation in patients with and without spontaneous ventricular tachyarrhythmias. Am J Cardiol. 1987;59:586–91.

    Article  PubMed  CAS  Google Scholar 

  65. Kuchar DL, Thorburn CW, Sammel NL. Prediction of serious arrhythmic events after myocardial infarction: signal averaged electrocardiogram, Holter monitoring and radio-nuclide ventriculography. J Am Coll Cardiol. 1987;9:531–9.

    Article  PubMed  CAS  Google Scholar 

  66. Gomes JAC, Horowitz S, Milner M, Machac J, Winters SL, Barreca P. Signal averaging of the QRS complex in myocardial infarction: relationship between ejection fraction and wall motion abnormalities. Am J Cardiol. 1987;59:1071–7.

    Article  PubMed  CAS  Google Scholar 

  67. Cripps TE, Bennett ED, Camm AJ, Ward D. Prospective evaluation of clinical assessment, exercise testing and signal averaged electrocardiogram in predicting outcome after acute myocardial infarction. Am J Cardiol. 1988;62:995–1001.

    Article  PubMed  CAS  Google Scholar 

  68. Hombach V, Höher M, Höpp HW, et al. Value of high resolution electrocardiography in identification of patients at risk. Herz. 1990;15:28–41.

    PubMed  CAS  Google Scholar 

  69. Hombach V, Eggeling T, Weismüller P, et al. High resolution ECG, Holter ECG monitoring and electrophysiologic studies for risk stratification and evaluation of antiarrhythmic therapy. J Amb Mon. 1959;2:33–45.

    Google Scholar 

  70. Höpp HW, Hombach V, Braun V, Behrenbeck DW, Tauchert M, Hilger HH. Ventricular delayed depolarisations in patients with chronic stable coronary heart disease and with acute myocardial infarction. In: Hombach V, Hilger HH, editors. Signal Averaging Technique in Clinical Cardiology. Stuttgart-New York: Schattauer-Publishers; 1981:233–52.

    Google Scholar 

  71. Höpp HW. Der Plötzliche Herztod-Pathophysiologie und Klinik bei Koronarer Herzkrankheit. Stuttgart-New York: Schattauer-Publishers; 1987.

    Google Scholar 

  72. Höher M, Sauer H, Eggeling T, Weismüller P, Hombach V. Neural networks improve late potential analysis from signal averaged ECG (abstr). Circulation. 1992; in press.

    Google Scholar 

  73. Buxton AE. Late potentials and syncope. In: El-Sherif N, Turitto G, editors. High Resolution Electrocardiography. New York: Futura Publishing Company; 1992:521–32.

    Google Scholar 

  74. Hombach V, Höpp HW, Kebbel U, et al. Recovery of ventricular late potentials from body surface using the signal averaging and high resolution ECG techniques. Clin Cardiol. 1986;9:361–8.

    Article  PubMed  CAS  Google Scholar 

  75. Eggeling T, Höpp HW, Osterspey A, Hombach V, Hilger HH. Significance of diastolic microvolt potentials in patients with long QT syndrome. New Trends Arrhyth. 1986;2:21–4.

    Google Scholar 

  76. Eggeling T, Höpp HW, Schickendantz S, et al. Diastolic micropotentials within the high resolution surface ECG in the QT syndrome. Z Kardiol. 1986;75:410–6.

    PubMed  CAS  Google Scholar 

  77. Eggeling T. Experimentelle und klinische Untersuchungen zum QT-Syndrom. Stuttgart: Hippokrates Verlag; 1992.

    Google Scholar 

  78. Höher M, Axmann J, Sauer H, Weismüller P, Kochs M, Hombach V. Beat-to-beat variability of ventricular late potentials in the unaveraged high-resolution electrocardiogram (abstr). Circulation. 1992; in press.

    Google Scholar 

Download references

Authors
  1. Vinzenz Hombach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Höher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kochs
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Eggeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Weismüller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Wiecha
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. The Mount Sinai School of Medicine of CUNY, USA

    J. Anthony Gomes (Professor of Medicine, Director) (Professor of Medicine, Director)

  2. Section of Electrocardiography and Electrophysiology, Mount Sinai Medical Center, New York, USA

    J. Anthony Gomes (Professor of Medicine, Director) (Professor of Medicine, Director)

Rights and permissions

Reprints and permissions

Copyright information

© 1993 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Hombach, V., Höher, M., Kochs, M., Eggeling, T., Weismüller, P., Wiecha, J. (1993). Clinical significance of high resolution electrocardiography — sinus node, His bundle and ventricular late potentials. In: Gomes, J.A. (eds) Signal Averaged Electrocardiography. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-0894-2_15

Download citation

  • DOI: https://doi.org/10.1007/978-94-011-0894-2_15

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4386-1

  • Online ISBN: 978-94-011-0894-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation