Effects of Extracardiac Factors in Signal-Averaged Electrocardiography-measured Late Potentials from Early Anterior Myocardial Infarction in Intensive Cardiac Care Unit

Christopher Surya Suwita, Sally Aman Nasution, Muhadi Muhadi, Juferdy Kurniawan


Background: one modality that can predict ventricular arrhythmias after myocardial infarction (MI), particularly anterior MI, is signal-averaged electrocardiogram (SA-ECG), through the detection of late potentials (LP) which is a substrate for ventricular arrhythmias. Extracardiac factors, which are also risk factors for MI, such as hypertension, diabetes, dyslipidemia, and obesity, are apparently associated with post-MI ventricular arrhythmias, which in turn may be correlated with LP. This study aims to determine the effect of extracardiac risk factors on LP incidence in anterior MI patients treated in the intensive cardiac care unit (ICCU). Methods: this was a cross-sectional study in which 80 subjects with anterior MI during the period of December 2018-2019 underwent SA-ECG examination. The medical history and extracardiac risk factors were recapitulated, and then the SA-ECG data was taken from either direct examination or ICCU patients’ database in that period. This study used multivariate analysis with logistic regression test. Results: the most common factors found were hypertension (70.00%), followed by dyslipidemia (56.25%), diabetes (46.25%), and obesity (38.75%). Obesity and dyslipidemia are extracardiac factors with the two biggest roles in the prevalence of LP. However, from additional analysis, we found that diabetes with acute hyperglycemia also had immense influence on the occurrence of LP. The OR for diabetes with acute hyperglycemia, obesity, and dyslipidemia were 4.806 (IK95% 0.522-44.232), 4.291 (IK95% 0.469-39.299), and 3.237 (IK95% 0.560-18.707). However, the association is not statistically significant. Conclusion: patients with anterior MI who suffer from diabetes with hyperglycemia in admission, obesity, and dyslipidemia have a potentially higher LP prevalence, despite statistical insignificance. To increase the prognostic value of SA-ECG, serial examinations are needed during hospitalization.


diabetes; dyslipidemia; hypertension; late potentials; myocardial infarction; obesity; signal-averaged electrocardiogram


World Heart Organization. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization; 2011.

Grech ED, Ramsdale DR. Acute coronary syndrome: unstable angina and non-ST segment elevation myocardial infarction. BMJ. 2003;326(7401):1259-61.

Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics – 2011 update: a report from the American Heart Association. Circulation. 2011; 123:18–209.

Kolansky DM. Acute coronary syndromes: mortality, morbidity, and pharmacoeconomic burden. Am J Manag Care. 2009;15:36-41.

Tousek P, Tousek F, Horak D, et al. The incidence and outcomes of acute coronary syndromes in a central European country: Results of the CZECH-2 registry. Int J Cardiol. 2014;173:204–8.

Kumar A, Cannon CP. Acute coronary syndrome: diagnosis and management. Mayo Clin Proc. 2009;84(1)):917-38.

Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. The Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. JACC. 2012;60(10):4-5.

Grasso AW, Brener SJ. Complications of acute myocardial infarction. [Online] 2014 [Cited Oct 30 2018]. Available from: URL: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/complications-of-acute-myocardial-infarction.

Sobel BE, Corr PB, Robison AK, Goldstein RA, Witkowski FX, Klein MS. Accumulation of lysophosphoglycerides with arrhythmogenic properties in ischemic myocardium. J Clin Invest. 1978;62(3):546.

Gorenek B, Blomström Lundqvist C, Brugada Terradellas J, et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Euro Intervention. 2015;10(9):1095-108.

Henriques JS, Gheeraert PJ, Ottervangera JP, et al. Ventricular fibrillation in acute myocardial infarction before and during primary PCI. Int J Cardiol. 2005; 105:262–6.

Gheeraert PJ, Henriques JS, De Buyzere ML, et al. Out-of-hospital ventricular fibrillation in patients with acute myocardial infarction: coronary angiographic determinants. J Am Coll Cardiol. 2000;35(1):144-50.

Hreybe H, Saba S. Location of acute myocardial infarction and associated arrhythmias and outcome. Clin. Cardiol. 2009;32(5):274–7.

Turitto G, Benson MD, Wong BC, El-Sherif N. Signal averaged ECG. [Online] 2013 [Cited Oct 31 2018]. Available from: URL: https://www.researchgate.net/publication/278651374_Signal_averaged_ECG.

Cain ME, Anderson JL, Arnsdorf MF, Mason JW, Scheinman MM, Waldo AL. Signal-averaged electrocardiography. JACC. 1996;27:238–49.

Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315.

Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting presenting with ST-segment elevation: The Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77.

Mohseni J, Kazemi T, Maleki MH, Beydokthi H. A systematic review on the prevalence of acute myocardial infarction in Iran. Heart Views. 2017; 18(4):125-32.

Abu-Assi E, Lopez A, Salvado VG, et al. The risk of cardiovascular events after an acute coronary event remains high, especially during the first year, despite revascularization. Rev Esp Cardiol. 2016; 69(1):11-8.

Ge J, Li J, Yu H, Hou B. Hypertension is an independent predictor of multivessel coronary artery disease in young adults with acute coronary syndrome. Int J Hypertens. 2018;2018:7623639.

Komatsu S, Panes J, Russell JM, et al. Effects of chronic arterial hypertension on constitutive and induced intercellular adhesion molecule-1 expression in vivor. Hypertension. 1997;29(2):683-9.

Rosas M, Hermosillo AG, Infante O, Kuri J, Cardenas M. Relationship between the site of a myocardial infarction and signal-averaged electrocardiogram indices. Int J Cardiol. 1998; 63:129–40.

Turitto G, Risa AL, Zanchi E, Prati PL. The signal-averaged electrocardiogram and ventricular arrhythmias after thrombolysis for acute myocardial infarction. JACC. 1990;15(6):1270-7.

Dzavik V, Beanlands DS, Leddy D, Davies RF, Kimber S. Does late revascularization alter the evolution of the signal-averaged electrocardiogram in patients with a recent transmural myocardial infarction? Can J Cardiol. 1995;11(5):378-84.

Lander P, Gomis P, Goyal R, et al. Analysis of abnormal intra-QRS potentials: improved predictive value for arrhythmic events with the signal-averaged electrocardiogram. Circulation. 1997;95:1386-93.

Buxton AE, Simson MB, Falcone RA, Marchlinski FE, Doherty JU, Josephson ME. Results of signal-averaged electrocardiography and electrophysiologic study in patients with nonsustained ventricular tachycardia after healing of acute myocardial infarction. Am J Cardiol. 1987;60:80-5.

Mozos I. The relation between late ventricular potentials and electrocardiographic dispersion of ventricular activity in myocardial infarction patient. TMJ. 2006;56(2):157-62.

Savard P, Rouleau JL, Davies RF, et al. Prediction of arrhythmic events after myocardial infarction using signal-averaged ECG criteria specific for gender, age and myocardial infarction type. Circulation. 1994; 90(suppl I):I-389.

Mozos I, Serban C, Mihaescu R. Late ventricular potentials in cardiac and extracardiac diseases. [Online] 2012 [Cited Jan 27 2019]. Available from: URL: http://www.intechopen.com/books/cardiac-arrhythmias-new-considerations/late-ventricular-potentials-in-cardiac-and-extracardiac-diseases.

Dordevic D, Lovic B, Ilic MD, et al. Clinical significance of signal-averaged electrocardiogram in patients with arterial hypertension and left ventricular hypertrophy. Acta Fac Med Naiss. 2005;22(1):9-13.

Sugiki Y, Ohta M. Detection of ventricular late potentials and the incidence of ventricular tachycardia in diabetic patients, with reference to myocardial infarction. Nihon Ika Daigaku Zasshi. 1996; 63(6):481-9.

Malutu H, Joseph VF, Pangemanan J. Gambaran kadar glukosa darah pada pasien SKA di RSUP Prof. Dr. Rd. Kandou Manado periode Januari-Desember 2014. J E-Clin. 2016;4(1).

Tran HV, Gore JM, Darling CE, Ash AS, Kiefe CI, Goldberg RJ. Hyperglycemia and risk of ventricular tachycardia among patients hospitalized with acute myocardial infarction. Cardiovasc Diabetol. 2018; 17:136.

Nasution SAN. Peran hiperglikemia akut terhadap risiko aritmia maligna pada pasien infark miokard akut: telaah terhadap kerusakan miokard, perubahan kanal ion, dan faktor inflamasi [dissertation]. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2019.

Lalani AP, Kanna B, Kohn J, Ferrick KJ, Huber MS, Shapiro LE. Abnormal signal-averaged electrocardiogram (SAECG) in obesity. Obes Res. 2000;8(1):20-8.

Mozos I. Ventricular arrhythmia risk in noncardiac diseases. [Online] 2014 [Cited Nov 11 2019]. Available from: URL: http://www.intechopen.com/books/cardiac-arrhythmias-new-considerations/late-ventricular-potentials-in-cardiac-and-extracardiac-diseases.

Chu CS, Lee KT, Lee ST, et al. Effects of atorvastatin on ventricular late potentials and repolarization dispersion in patients with hypercholesterolemia. Kaohsiung J Med Sci. 2007;23:217–24.

Full Text: PDF


  • There are currently no refbacks.