SIGNAL AVERAGING ELECTROCARDIOGRAPHY IN C HRONIC-ALCOHOLISM

Cardiovascular death is the main cause of mortality in chronic alcohol ics, perhaps due to a pro-arrhythmogenic effect of alcohol associated with infraclinical myocardial lesions. The authors investigated prospe ctively 41 patients (average age : 49.7 years) who were chronic alcoho lics but had no acute alcoholic episodes for cardiac disease (ECG, sig nal averaging for late ventricular potentials, echocardiography and Ho lter ECG monitoring) and hepatic disease (liver biopsy). The history o f alcoholism was 14 +/- 9 years, the quantity of alcohol ingested befo re they stopped drinking being 89 +/- 31 grammes/day. Thirty per cent of patients displayed 2 or 3 criteria of late ventricular potentials ( LP). The authors demonstrated a correlation between the daily quantity of alcohol consumed before stopping drinking and the duration of the filtered QRS complex (p = 0.02). Moreover, the frequency of fatty infi ltration found on liver biopsy, greater in alcoholics with LP (35 % ve rsus 19 %, p = 0.025) correlated with the amplitude of the last 40 ms of the average QRS (p = 0.0485), with the duration of potentials of le ss than 40 mu volts (p = 0.05) and, above all, with the number of crit eria of LP (p = 0.02). Finally, the presence of LP was also related to the following biological abnormalities: GGT (p = 0.027), ASAT (p = 0. 046), ALAT (p = 0.039). The ECG abnormalities may reflect early infra- clinical myocardial lesions secondary to cellular metabolic abnormalit ies perhaps analogous to the fatty hepatic changes. However, the progn ostic value of these signal-averaging ECG abnormalities remains unknow n.