he high-frequency components (HFC) of the electrocardiography (ECG) have been classically described using a high-fidelity ECG, not by conventional 12-lead ECG. 1-3 Recent studies have described a method for the extraction of the low-amplitude and HFC of the ECG (L-HFCs) for the terminal portion of the QRS complex or the early portion of the ST segment of the signal-averaged ECG using high gain amplifications and signal-averaging techniques. 4-8 These L-HFCs, so-called 'late potentials', correspond to the delayed and fragmented endocardial or epicardial electrograms, and are believed to represent the substrate for reentrant ventricular tachycardia (VT). [4][5][6][7][8][9][10][11][12] The L-HFCs not only of the terminal portion of the QRS complex, but also within the QRS complex have been detected by analyzing the signals from catheter electrodes inserted into ventricles. 12 However, a potential problem with the signal-averaged ECG is the attenuation of the L-HFCs because of trigger jitter of the biological signals 7 and the beat-to-beat variation in the L-HFCs caused by the complex filtering and repeated summation-averaging required to improve the signal-to-noise ratio. Recent signal-averaged ECG studies have used a variety of high-and low-pass filters, but as these conventional filters were designed only for the terminal portion of the QRS complex or for the early ST segment, some signal distortion and filter artifact have been unavoidable. The low-frequency components Circulation Journal Vol.66, July 2002 dominate the energy of the QRS complex 13 and mask the HFCs. Furthermore, the L-HFCs within the QRS complex were undetectable in most of the previous studies that used the signal-averaging method. We report a novel ECG subtraction method for extracting the L-HFCs from within the QRS complex.
Methods
SubjectsThe subjects consisted of 25 healthy volunteers (Healthy group) and 58 patients with a previous myocardial infarction (MI): 21 consecutive patients with acute MI admitted to hospital between January 1995 and December 1997, and 37 patients with VT or suspected VT who were admitted between February 1990 and December 1994. The 58 patients were classified into 3 groups from the results of routine ECG check-ups and clinical Holter ECG studies: 38 patients without a history of VT (noVT-MI group), 13 patients with clinically documented spontaneous non-sustained VT (nonsusVT-MI group) and 7 patients with clinically documented spontaneous sustained VT (susVT-MI group) ( Table 1). The Healthy group consisted of all males (mean age, 28±2 years), the noVT-MI group had 33 males and 5 females (mean age, 60±12 years; 21 anterior MI and 17 inferior MI), the non-susVT-MI group had all males (mean age, 52±13 years; 10 anterior MI and 3 inferior MI), and the susVT-MI group comprised 6 males and 1 female (mean age, 61±8 years; 3 anterior MI and 4 inferior MI). The left ventricular ejection fraction was significantly less in the susVT-MI group (mean 36.2±5.6%, range 30-48%) than in the noVT-MI group (mean 53.3±12.6%, range 32-7...