EVALUATION OF HIGH AMPLIFICATION ECG AND THE STUDY OF SINUS VARIABILITY FOR THE DETECTION OF PATIENTS AT RISK OF SUDDEN-DEATH

In order to define the best strategy of prognostic evaluation in relat ion to patients in heart failure, 415 patients with impaired left vent ricular function (ejection fraction < 40 %) were prospectively include d, between June 1993 and 1996, in a study comparing the respective val ue of high amplification ECG and Holter analysis of sinus variability 308 patients in sinus rhythm and narrow QRS complexes were included. T he patients were distributed into 4 groups according to the presence o r absence of late potentials and altered sinus variability (group I wi th 2 normal examinations, group II with late potentials and normal var iability, group III without late potentials, but with altered variabil ity and group IV with 2 abnormal examinations). The sudden and overall mortality was significantly greater in groups III (28 and 11 %) and I V (28 and 9 %) than in group I (7 and 3 %) and II (11 and 2 %). The pr esence of potential was unable to identify patients at risk of ventric ular tachycardia and sudden death. In another 60 patients with complet e branch block, the prognosis was also correlated with the alteration of sinus variability. In conclusion, high amplification ECG correctly evauated the prognosis of subjects in heart failure. However, analysis of sinus variability should be systematically proposed to detect subj ects at high risk of mortality, whether the subject has large or narro w QRS complexes.