Kuchar D L, Thorburn C W, Sammel N L
Am J Cardiol. 1986 Nov 1;58(10):949-53. doi: 10.1016/s0002-9149(86)80017-0.
Signal-averaged electrocardiography (ECG) was performed in 150 consecutive patients presenting with syncope, to determine its diagnostic role in identifying patients with ventricular tachycardia (VT) and in determining their long-term prognosis. Patients also underwent a standardized investigational protocol to independently determine a cause of syncope. Twenty-nine patients had a late potential, 107 had a normal signal-averaged electrocardiogram and 14 had bundle branch block on 12-lead ECG. Signal-averaged ECG identified a late potential in 16 of 22 patients with VT and was normal in 101 of 114 patients in whom syncope was attributed to causes other than VT or remained unexplained (sensitivity 73%, specificity 89%, predictive accuracy 55%). In patients with coronary artery disease, the predictive accuracy increased to 82%. Absence of a late potential identified a group of patients with a very low incidence of VT. During follow-up of 1 to 20 months (median 11), 15 patients (10%) died, 6 suddenly. There was no significant difference in survival or recurrence of syncope between patients with and without a late potential. Signal-averaged ECG can noninvasively identify patients with serious ventricular arrhythmias among an unselected group presenting with syncope.
对150例连续就诊的晕厥患者进行了信号平均心电图（ECG）检查，以确定其在识别室性心动过速（VT）患者及判断其长期预后方面的诊断作用。患者还接受了标准化的调查方案以独立确定晕厥原因。29例患者有晚电位，107例患者信号平均心电图正常，14例患者12导联心电图有束支传导阻滞。信号平均心电图在22例VT患者中的16例中识别出晚电位，在114例晕厥原因归因于VT以外因素或原因不明的患者中的101例中表现正常（敏感性73%，特异性89%，预测准确性55%）。在冠心病患者中，预测准确性提高到82%。无晚电位识别出一组VT发生率极低的患者。在1至20个月（中位数11个月）的随访期间，15例患者（10%）死亡，6例为猝死。有晚电位和无晚电位的患者在生存率或晕厥复发方面无显著差异。信号平均心电图可在未经选择的晕厥患者群体中无创地识别出严重室性心律失常患者。
