Ventricular late potentials in signal-averaged ECG are a predictor of ventricular tachyarrhythmias in patients with coronary artery disease. The role of signal-average ECG in non-ischemic dilated cardiomyopathy has not been defined yet. We studied the prognostic impact of an abnormal signal-averaged ECG in 31 patients with non-ischemic dilated cardiomyopathy. All signal-averaged ECG recordings were analyzed by time-domain analysis as well as by frequency analysis with spectrotemporal mapping.
Results: In 13 (42%) patients time domain analysis and in 9 (29%) patients frequency analysis was found to be abnormal. During follow-up (13 +/- 7 months) seven (23%) patients developed spontaneous ventricular tachyarrhythmias. The mean ejection fraction and the results of programmed ventricular stimulation did not differ significantly between patients with and without clinical episodes. Abnormal time domain analysis was found in five (71%) patients with and in eight (33%) patients without spontaneous tachyarrhythmias (p = 0.07), and abnormal frequency analysis in 3 (43%) patients versus 6 (25%) patients (p = 0.36). The low-amplitude-signal duration was significantly increased in patients with tachyarrhythmias (p = 0.008). Ventricular tachyarrhythmias occurred in 38% of patients with abnormal time domain analysis and in 33% of patients with abnormal frequency analysis. In patients with normal signal-averaged ECG the incidence reached 11% and 18%. For time-domain analysis the sensitivity was 71%, specificity 67%, positive predictive value 38%, and negative predictive value 89%, for spectrotemporal mapping 43%, 75%, 33%, and 82%, respectively. The incidence of electrophysiologically inducible ventricular tachyarrhythmias in patients with abnormal signal-averaged ECG exceeded that in patients with normal findings.
Conclusion: In patients with non-ischemic dilated cardiomyopathy a normal signal-averaged ECG is associated with a reduced occurrence of ventricular tachyarrhythmic events. Thus, signal-averaged ECG contributes to the evaluation of these patients. The negative predictive value exceeded the positive predictive value.