Detection of late potentials on the surface electrocardiogram in unexplained syncope

To assess the usefulness of signal averaging of the surface electrocardiogram for detecting hitherto undocumented ventricular tachycardia (VT) in patients with unexplained syncope, 24 such patients were evaluated by electrocardiography and programmed ventricular stimulation. The surface electrocardiograms of 15 normal volunteers and 22 patients with documented sustained VT were also examined. No study subject had a bundle branch block or a QRS duration longer than 120 ms. Sustained VT was recorded in 9 of the 24 patients with syncope (8 patients with inducible VT and 1 with a spontaneous episode of recorded sustained VT). The signal-processed electrocardiogram contained late potentials and a filtered QRS duration longer than 120 ms in 8 of these 9 patients (89% sensitivity). None of the remaining 15 patients had these electrocardiographic abnormalities. Similar results were found in the patients with previously documented sustained VT (82% sensitivity) and in normal volunteers (no instances of abnormal recordings). In patients with unexplained syncope, signal processing of the surface electrocardiogram may be a sensitive and specific noninvasive test for detecting a high-risk subset of patients prone to lethal ventricular tachyarrhythmias.