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Title: HIGH RESOLUTION ECG/ SIGNAL AVERAGED ECG
Description: Notes on indications for procedure, measurements needed for positive test, lead positions and lead system used. Explanation of late potentials and slow propagation
Description: Notes on indications for procedure, measurements needed for positive test, lead positions and lead system used. Explanation of late potentials and slow propagation
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HIGH RESOLUTION ECG (SIGNAL AVERAGED ECG)
It is used to identify slow propagation of myocardial conduction that is not evident on a
surface ECG
...
Conduction abnormalities are shown as “late potentials” on the signal averaged ECG
...
PROPERTIES OF POTENTIALS:
• LATE: they occur at the latter part of depolarisation (therefore occur at the terminal
portion of the QRS complex)
...
• LOW AMPLITUDE: abnormal propagation through areas of slow conduction means
low amplitude signals occur due to the small amount of tissue being propagated
...
On a surface ECG it can look like right bundle branch block (RBBB) with J point elevation/ ST
elevation typically occurring in leads V1-‐V3
...
This is the
addition of every extra cellular action potential that leads to ventricular depolarisation
...
These are clinically significant
as they represent slow conduction
...
Ideally
the noise is reduced to 0
...
This enhances the detection of low amplitude signals by
amplifying the terminal portion of the QRS complex
...
Subdued lighting
The electode sight must be clean to reduce baseline wander
...
X Lead = HOROZONTAL PLANE (V6 – V6R also known as I)
Y Lead = VERTICAL PLANE (E-‐ H)
Z Lead = SAGITAL PLANE (Left leg – M)
All limb leads are required, and apply V4 and V6
...
I – right midauxillary line, same plane as V4 and V6
E-‐ Anterior, mid sternum on the same horizontal level as V4 and V6
H-‐ Centre of the back of the neck
M-‐ Posterior, centre of the back “opposite” E
MEASUREMENTS:
Root mean squared (RMS) voltage of final 40ms of QRS
Duration of low amplitude signals (LAS) lass that 40um
Duration of entire signal of complex
POSITIVE TEST:
Must meet at least 2 of the 3 criteria
1
...
LAS less than 38ms
3
...
Title: HIGH RESOLUTION ECG/ SIGNAL AVERAGED ECG
Description: Notes on indications for procedure, measurements needed for positive test, lead positions and lead system used. Explanation of late potentials and slow propagation
Description: Notes on indications for procedure, measurements needed for positive test, lead positions and lead system used. Explanation of late potentials and slow propagation