Prognostic significance of ventricular late potentials in coronary artery disease

By means of high-gain ECG and signal-averaging techniques, we tried to determine the prevalence and prognostic significance of ventricular late potentials (VLPs) in coronary artery disease (CAD). No VLPs were detected in normal subjects (n = 25) or in patients with various noncoronary cardiopathies with sustained ventricular tachycardia and/or fibrillation (VT/VF) (n = 10). Among 92 CAD patients, VLPs were apparent in 35% (32 of 92) at the beginning of the study. The prevalence of VLPs increased to 48% (19 of 40) in the presence of ventricular aneurysm (VA) and to 82% (14 of 17) in the presence of a history of previous sustained VT/VF. To determine the prognostic significance of VLPs, a prospective analysis was conducted during a mean of 7.4 months (range 1 to 22 months). During the follow-up period, 11 patients (12%) presented with an episode of sustained VT/VF, and six of them died from documented VT/VF. Three other patients died from cardiogenic shock. An episode of sustained VT/VF occurred in 31% (10 of 32) of the patients with VLPs vs 2% (1 of 58) of the patients without VLPs ( p < 0.001), and six patients with VLPs died from sustained VT/VF vs none in the group of patients without VLPs ( p < 0.01). This VLP-related increase in arrhythmic risk was still present in the particular subgroup of patients with a history of previous sustained VT/VF (n = 17) and in patients with VA (n = 40). The risk of developing sustained VT/VF was also influenced by the length of the VLP and by a low mean ejection fraction. For predicting sudden arrhythmic death, VLP detection had a high sensitivity (six of six patients), a specificity of 69%, and a predictive value of 19%; for predicting sustained VT/VF, VLP detection has a sensitivity of 90%, a specificity of 72%, and a predictive value of 31%. We conclude that VLPs are a frequent finding in CAD, that they are mainly associated with the presence of VA, and that their presence increases the risk of sustained VT/VF and sudden arrhythmic death in CAD.