Skip to main content
SpringerLink
Log in

High resolution electrocardiography. Basic and clinical aspects

  • Chapter
Electrocardiography and Cardiac Drug Therapy

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 92))

Abstract

There are several low level electrocardiographic (ECG) potentials whose manifestations on the body surface are too small to be detected by routine measurement techniques. These include the potentials produced by the His-Purkinje system and by slow conduction in depressed ventricular myocardium (usually called late potentials). These potentials are small because the activation front is slow and fractionated or the mass of tissue undergoing depolarization is small or both. However, the measurement of the bioelectric potentials produced by these tissues is important for diagnostic purposes. Identification of the His-Purkinje potential can localize the site of atrio-ventricular conduction disorders, and the detection of late potentials may identify patients at high risk of malignant tachyarrhythmias. The problem in identifying these potentials is that the signal is smaller than the electric noise produced by various sources. Two different techniques have been utilized to improve signal-to-noise ratio: 1) temporal averaging (usually referred as to as signal averaging). This technique is applicable only to repetitive ECG signals and cannot detect moment by moment dynamic changes in the signals. 2) Low noise or high resolution ECG, which utilizes spatial averaging techniques, as well as other noise reducing measures, to record the His-Purkinje signal and late potentials on a beat-to-beat basis. The signal averaged technique has been utilized more often in the last few years and the averaged signal can be analyzed in either the time or frequency domain.

Supported by National Institutes of Health Grants, HL 31341, HL 36680 and HC 65067 and by the Veterans Administration Medical Research Funds.

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 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight 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. Ros HH, Koeleman ASM, Van der Akker TJ (1981) The technique of signal averaging and its practical application in the separation of atrial and His-Purkinje activity. In: Hombach V, Hilger HH (eds) Signal averaging technique in clinical cardiology. New York: Schattauer Verlag, pp 3–14

    Google Scholar 

  2. Restivo M, El-Sherif N, Kelen GJ, Henkin R, Craelius W, Gough WB (1985) Correlation of late potentials on the body surface and ventricular activation maps of reentrant circuits in the post-infarction dog heart. Circulation Abstr 72:Suppl. III-11.

    Google Scholar 

  3. Abboud S, Beihassen B, Laniado S, Sadeh D (1983) Non-invasive recording of late ventricular activity using an advanced method in patients with a damaged mass of ventricular tissue. J. Electrocardiol 16:245.

    Article  PubMed  CAS  Google Scholar 

  4. Simson MB, Euler D, Michelson EL, Falcone RA, Spear JF, Moore EN (1981) Detection of delayed ventricular activation on the body surface in dogs. Am J Physiol 24:H363

    Google Scholar 

  5. Berbari E, Collins S, Salu Y, Arzbaecher R (1983) Orthogonal surface lead recordings of His-Purkinje activity: comparison of actual and simulated waveforms. IEEE Trans Biomed Eng BME-30:160

    Article  CAS  Google Scholar 

  6. Abboud S, Sadeh D (1982) The waveforms’ alignment procedure in the averaging process for external recording of the His bundle activity. Comput Biomed Res 15:212

    Article  PubMed  CAS  Google Scholar 

  7. Wolf HK, MacInnis PJ, Stock S, Helppi RK, Rautaharju PM (1972) Computer analysis of rest and exercise electrocardiograms. Comput Biomed Res 5:329

    Article  PubMed  CAS  Google Scholar 

  8. Wajszczuk WJ, Moskowitz MS, Bauld T, Dabos P, Weiss R, Rubenfire M (1978) Non-inverse external recording of cardiac conduction system (His bundle) activity. Med Instrum 12:282

    PubMed  CAS  Google Scholar 

  9. Brandon CW, Brody DA (1970) A hardware trigger for temporal indexing of the electrocardiographic signal. Comput Biomed Res 3:47

    Article  PubMed  CAS  Google Scholar 

  10. Goovaerts HG, Ros HH, Van Der Akker TJ, Schneider H (1976) A digital QRS detector based on the principle of contour limiting. IEEE Trans Biomed Eng BME-23:154

    Article  CAS  Google Scholar 

  11. Borjesson PO, Pahlm O, Sornmo L, Nygards ME (1982) Adaptive QRS detection based on maximum a posteriori estimation. IEEE Trans Biomed Eng BME-29:341

    Article  CAS  Google Scholar 

  12. Thakor NV, Webster JG, Tompkins WJ (1983) Optimal QRS detector. Med Biol Eng Comput 21:343

    Article  PubMed  CAS  Google Scholar 

  13. Tremblay G, LeBlanc AR (1985) Near-optimal signal preprocessor for positive cardiac arrhythmia identification. IEEE Trans Biomed Eng BME-32:141

    Article  CAS  Google Scholar 

  14. Uijen GJH, deWeerd JPC, Vendrik AJH (1979) Accuracy of QRS detection in relation to the analysis of high-frequency components in the electrocardiogram. Med Biol Eng Comput 17:492

    Article  PubMed  CAS  Google Scholar 

  15. Fraden J, Neuman MR (1980) QRS wave detection. Med Biol Eng Comput 18:125

    Article  PubMed  CAS  Google Scholar 

  16. Craelius W, Restivo M, Assadi MA, El-Sherif N (1986) Criteria for optimal averaging of cardiac signals. IEEE Trans Biomed Eng BME-33:957

    Article  CAS  Google Scholar 

  17. El-Sherif N, Mehra R, Gomes JAC, Kelen G (1983) Appraisal of a low noise electrocardiogram. J Am Coll Cardiol 1:456

    Article  PubMed  CAS  Google Scholar 

  18. El-Sherif N (1984) The low noise (high resolution) electrocardiogram. Int J Cardiol 6:185

    Article  Google Scholar 

  19. Flowers NC, Shvartsman V, Kennelly BM, Sohi GS, Horan LG (1981) Surface recordings of His-Purkinje activity on an every beat basis without digital averaging. Circulation 63:948

    Article  PubMed  CAS  Google Scholar 

  20. Flowers NC, Shvartsman V, Horan LG et al (1983) Analysis of PR subintervals in normal subjects and early studies in patients with abnormalities of the conduction system using surface His bundle recordings. J Am Coll Cardiol 2:939

    Article  PubMed  CAS  Google Scholar 

  21. Hombach V, Kebbel U, Hopp H-W, Winter V, Hirche, H (1984) Non-invasive beat-to-beat registration of ventricular late potentials using high resolution electrocardiography. Int J Cardiol 6:167

    Article  PubMed  CAS  Google Scholar 

  22. Hombach V, Hopp H-W, Kebbel U, Treis I, Osterpey A, Eggeling T, Winter U, Hirche H, Hilger HH (1986) Recovery of ventricular late potentials from body surface using the signal averaging and high resolution ECG techniques. Clin Cardiol 9:361

    Article  PubMed  CAS  Google Scholar 

  23. Mehra R, Restivo M, El-Sherif N (1983) Electromyographic noise reduction for high resolution electrocardiography. In: IEEE Frontiers of Engineering and Computing in Health Care. New York:IEEE, p 298

    Google Scholar 

  24. Waldo AL, Kaiser GA (1973) A study of ventricular arrhythmias associated with myocardial infarction in the canine heart. Circulation 47:1222

    PubMed  CAS  Google Scholar 

  25. Boineau JP, Cox JL (1973) Slow ventricular activation in acute myocardial infraction in the canine heart. A source of reentrant premature ventricular contractions. Circulation 48:702

    PubMed  CAS  Google Scholar 

  26. El-Sherif N, Scherlag BJ, Lazzara R (1975) Electrode catheter recordings during malignant ventricular arrhythmias following experimental acute myocardial ischemia. Circulation 51:1003

    PubMed  CAS  Google Scholar 

  27. El-Sherif N, Scherlag BJ, Lazzara R, Hope RR (1977) Reentrant ventricular arrhythmias in the late myocardial infarction period. I. Conduction characteristics in the infarction zone. Circulation 55:586

    Google Scholar 

  28. Janse MJ, VanCapelle FJL, Morsink M, Kleber AG, Wilms-Schopmaan F, Cardinal R, D’Alnoncourt CN, Durrer D (1980) Flow of “injury” current and patterns of excitation during early ventricular arrhythmias in acute regional myocardial ischemia in isolated porcine and canine hearts. Circ Res 47:151

    PubMed  CAS  Google Scholar 

  29. El-Sherif N, Smith RA, Evans K (1981) Ventricular arrhythmias in the late myocardial infarction period in the dog. 8. Epicardial mapping of reentrant circuits. Circ Res 49:255

    PubMed  CAS  Google Scholar 

  30. Mehra R, Zeiler RH, Gough WB, EL-Sherif N (1983) Reentrant ventricular arrhythmias in the late myocardial infarction period 9. Electrophysiologic-anatomical correlation of reentrant circuits. Circulation 67:11

    Article  PubMed  CAS  Google Scholar 

  31. El-Sherif N, Mehra R, Gough WB, Zeiler RH (1983) Reentrant ventricular arrhythmias in the late myocardial infarction period. Interruption of reentrant circuits by cryothermal techniques. Circulation 68:644

    Article  PubMed  CAS  Google Scholar 

  32. Berbari EJ, Scherlag BJ, Hope RR, Lazzara R (1978) Recording from the body surface of arrhythmogenic ventricular activity during the S-T segment. Am J Cardiol 41:697

    Article  PubMed  CAS  Google Scholar 

  33. Simson MB, Untereker WJ, Spielman SR, Horowitz LN, Marcus NH, Falcone KA, Harken AH, Josephson ME (1983) The relationship between late potentials on the body surface and directly recorded fragmented electrograms in patients with ventricular tachycardia. Am J Cardiol 51:105

    Article  PubMed  CAS  Google Scholar 

  34. Gough WB, Mehra R, Restivo M, Zeiler RH, El-Sherif N (1985) Reentrant ventricular arrhythmias in the late myocardial infarction period in the dog. 13. Correlation of activation and refractory maps. Circ Res 57:432

    PubMed  CAS  Google Scholar 

  35. Restivo M, Henkin R, Craelius W, El-Sherif N (1986) Are regions of delayed activation during a basic rhythm the responsible arrhythmogenic substrate for reentry (abstr.)? J Am Coll Cardiol 7:85A

    Google Scholar 

  36. Berbari EJ, Lazzara R, Samet P, Scherlag BJ (1973) Noninvasive technique for detection of electrical activity during the P-R segment. Circulation 48:1005

    PubMed  CAS  Google Scholar 

  37. Flowers NC, Hand RC, Orander PC, Miller CB, Walden MO, Horan LG (1974) Surface recording of electrical activity from the region of the bundle of His. Am J Cardiol 33:384

    Article  PubMed  CAS  Google Scholar 

  38. Stopczyk MJ, Kopec J, Zochowski RJ, Pleniak M (1973) Surface recording of electrical heart activity during the P-R segment in man by computer averaging technique. Int Res Com Sys 11:73

    Google Scholar 

  39. Hishimoto Y, Sawayama T (1975) Noninvasive recording of His bundle potential in man. Br Heart J 37:635

    Article  PubMed  CAS  Google Scholar 

  40. Furness A, Sharratt GP, Carson P (1975) The feasibility of detecting His bundle activity from the body surface. Cardiovsc Res 9:390

    Article  CAS  Google Scholar 

  41. Berbari EJ, Scherlag BJ, El-Sherif N, Befeler B, Aranda JM, Lazzara R (1976) The His-Purkinje electrocardiogram in man. Circulation 54:219

    PubMed  CAS  Google Scholar 

  42. Vincent R, Stroud NP, Jenner R, English MJ, Woollons DJ, Chamberlain DA (1978) Noninvasive recording of electrical activity in the PR segment in man. Br Heart J 40:124

    Article  PubMed  CAS  Google Scholar 

  43. Wajszczuk WJ, Stopczyk MJ, Moskowitz MS, Zochowski RJ, Bauld T, Dabos PL, Rubenfire M (1978) Noninvasive recording of His-Purkinje activity in man by QRS-triggered signal averaging. Circulation 58:95

    PubMed  CAS  Google Scholar 

  44. Berbari EJ, Lazzara R, Scherlag BJ (1979) The effects of filtering the His-Purkinje system electrocardiogram. IEEE Trans Biomed Eng 2:82

    Article  Google Scholar 

  45. McKenna WJ, Rowland E, Mortara D, Dawson RE, Krikler DM (1979) Noninvasive recording of the His bundle electrogram (abstr.). Proc VIth World Symposium on Cardiac Pacing. PACE 2:1978

    Google Scholar 

  46. Mehra R, Kelen GJ, Zeiler RH, Zephiran D, Fried P, Gomes JAC, El-Sherif N (1982) Noninvasive His bundle electrogram: value of three vector lead recordings. Am J Cardiol 49:344

    Article  PubMed  CAS  Google Scholar 

  47. Kanovsky MS, Falcone RA, Dresden CA, Josephson ME, Simson MB (1984) Identification of patients with ventricular tachycardia after myocardial infarction: signal-averaged electrocardiogram, Holter monitoring, and cardiac catheterization. Circulation 70:264

    Article  PubMed  CAS  Google Scholar 

  48. Denes P, Uretz E, Santarelli P (1984) Determinants of arrhythmogenic ventricular activity detected on the body surface QRS in patients with coronary artery disease. Am J Cardiol 53:1519

    Article  PubMed  CAS  Google Scholar 

  49. Buckingham TA, Ghosh S, Howan SM, Thessen CC, Redd RM, Stevens LL, Chaitman BR, Kennedy HL (1987) Independent value of signal-averaged electrocardiography and left ventricular function in identifying patients with sustained ventricular tachycardia and coronary artery disease. Am J Cardiol 59:568

    Article  PubMed  CAS  Google Scholar 

  50. Breithardt G, Borggrefe M, Haerten K (1986) Ventricular late potentials and inducible ventricular tachyarrhythmias as a marker for ventricular tachycardia after myocardial infarction. Eur Heart J 7(Suppl A): 127

    PubMed  Google Scholar 

  51. Turitto G, Fontaine J, Macina G, Caref E, Ursell S, Stavens C, El-Sherif N et al. (1987) Signal averaged ECG predicts the inducibility of sustained ventricular tachycardia in patients with spontaneous non-sustained tachycardia (abstr.). J. Am Coll Cardiol 9:151A

    Google Scholar 

  52. Kertes PJ, Glabus M, Murray A, Julian DG, Campbell RWF (1984) Delayed ventricular depolarization: correlation with ventricular activation and relevance to ventricular fibrillation in acute myocardial infarction. Eur Heart J 5:974

    PubMed  CAS  Google Scholar 

  53. Gomes JA, Mehra R, Barreca P, El-Sherif N, Hariman R, Holtzman 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.

    Article  PubMed  CAS  Google Scholar 

  54. Turitto G, Macine G, Caref E, Mittleman R, Henkins R, El-Sherif N (1886) Lack of correlation between Holter recording and signal averaged electrocardiogram in the post-infarction period (abstr.). Circulation 74(Suppl 2): 11–402

    Google Scholar 

  55. Breithardt G, Schwarzmayer J, Borggrefe M, Haerten J, Seipel L (1983) Prognostic significance of late ventricular potentials after acute myocardial infarction. Eur Heart J 4:487

    PubMed  CAS  Google Scholar 

  56. Breithardt G, Borggrefe M (1986) Pathophysiological mechanisms and clinical significance of ventricular late potentials. Eur Heart J 7:364

    PubMed  CAS  Google Scholar 

  57. Denniss AR, Richards DA, Cody DV, Russell PA, Young AA, Cooper MJ, Ross DL, Uther JB (1986) Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal-averaged electrocardiogram of survivors of acute myocardial infarction. Circulation 74:731

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  60. Denes P, Santarelli P, Hauser RG, Uretz EF (1983) 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 67:1129

    Article  PubMed  CAS  Google Scholar 

  61. Cain ME, Ambos HD, Witkowski FX, Sobel BE (1984) Fast-Fourier transform analysis of signal-averaged electrocardiograms for identification of patients prone to sustained ventricular tachycardia. Circulation 69:711

    Article  PubMed  CAS  Google Scholar 

  62. Cain ME, Ambos HD, Markham J, Fischer AE, Sobel BE (1985) Quantification of differences in frequency content of signal-averaged electrocardiogram between patients with and without sustained ventricular tachycardia. Am J Cardiol 55:1500

    Article  PubMed  CAS  Google Scholar 

  63. Lindsay BD, Ambos HD, Schechtman KB, Cain ME (1986) Improved selection of patients for programmed ventricular stimulation by frequency analysis of signal-averaged electrocardiograms. Circulation 73:675

    Article  PubMed  CAS  Google Scholar 

  64. Henkin R, Kelen G, El-Sherif N (1986) Correlation between late potentials and frequency (FFT) analysis of signal averaged ECG—importance of analyzed segment duration (abstr.). Circulation 74(Suppl II):II-781

    Google Scholar 

  65. El-Sherif N, Gomes JAC, Restivo M, Mehra R (1985) Late potentials and arrhythmo- genesis. PACE 8:440

    PubMed  CAS  Google Scholar 

  66. Kelen GJ, Henkin R, Restivo M, Zeiler RH, Caref EB, El-Sherif N (1986) Signal averaging of high gain Holter EKG recordings. Validation of a new technique for detection of after potentials (abstr.). J Am Coll Cardiol 7:104A

    Google Scholar 

  67. Kelen GJ, Henkin R, Howard M, Ferraro C, El-Sherif N (1987) Serial signal averages from Holter tapes may reveal intermittent or changing late potentials (abstr.). PACE: (in press)

    Google Scholar 

  68. Craelius W, Chen VKH, Restivo M, El-Sherif N (1986) Rhythm analysis of arterial blood pressure. IEEE Trans Biomed Eng BME-33.1166

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Health Science Center and the Veterans Administration Medical Center, State University of New York, Brooklyn, New York, USA

    Nabil El-Sherif, Mark Restivo, William Craelius, Raphael Henkin, George Kelen, John M. Fontaine, Shantha N. Ursell & Gioia Turitto

Authors
  1. Nabil El-Sherif
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Restivo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Craelius
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raphael Henkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George Kelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. John M. Fontaine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shantha N. Ursell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gioia Turitto
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Cardiology-Angiology-Pneumology, University Hospital Ulm, Ulm, Germany

    V. Hombach

  2. Department of Cardiology - Angiology - Pneumology, University of Cologne, Cologne, Germany

    H. H. Hilger

  3. Division of Cardiology, St. Louis University, School of Medicine, St. Louis, Missouri, USA

    H. L. Kennedy

Rights and permissions

Reprints and permissions

Copyright information

© 1989 Kluwer Academic Publishers

About this chapter

Cite this chapter

El-Sherif, N. et al. (1989). High resolution electrocardiography. Basic and clinical aspects. In: Hombach, V., Hilger, H.H., Kennedy, H.L. (eds) Electrocardiography and Cardiac Drug Therapy. Developments in Cardiovascular Medicine, vol 92. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-1081-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-94-009-1081-2_16

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6976-2

  • Online ISBN: 978-94-009-1081-2

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation