Frequency versus time domain analysis of signal-averaged electrocardiograms. III. Stratification of postinfarction patients for arrhythmic events
O Odemuyiwa,
M Malik,
J Poloniecki,
T Farrell,
P Kulakowski,
T Millane,
A Staunton,
and
J Camm
Department of Cardiological Sciences, St. George's Hospital Medical School, London, England.
The predictive characteristics of spectral temporal analysis and time domain analysis of the signal-averaged electrocardiogram (ECG) for postinfarction arrhythmic events were compared in 257 patients. During a 6-month follow-up period, 7 patients (2.7%) died suddenly and 9 (3.5%) developed spontaneous sustained ventricular tachycardia. The mean numeric values of the standard time domain signal-averaged ECG variables in patients without arrhythmic events differed significantly from those in patients with arrhythmic events. The mean values of the spectral temporal signal-averaged ECG variables did not differ between the two patient groups. A strategy requiring positivity in any two time domain signal-averaged ECG variables provided the optimal receiver operating characteristic curves for predicting arrhythmic events. With spectral temporal analysis, a strategy using the Hanning window and diagnosing a positive signal-averaged ECG when two variables were abnormal provided the optimal curve for predicting arrhythmic events. Receiver operating characteristic curves showed that over a wide range of sensitivity, time domain variables had higher specificity for predicting arrhythmic events than did spectral temporal variables. Time domain analysis also provided significantly fewer false positive results than did spectral temporal analysis up to sensitivity values of 70%. It is concluded that time domain analysis of the signal-averaged ECG is superior to spectral temporal analysis for predicting arrhythmic events after myocardial infarction.
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