gms | German Medical Science

The standard 12 lead ECG, a ten second snapshot of cardiac electrical activity, is notoriously poor as a test for detecting proarrhythmic states or predicting arrhythmia occurrence. Heart rate variability, QT:RR assessment, and T wave alternans (TWA) individually have provided evidence that support the likelihood of improved detection and prediction of states of increased arrhythmia risk through the analysis of long term recordings. We present an integrated array of robust measurements and analyses that offer a platform for tracking changes in dynamic electrophysiologic states. These include estimates of mean depolarization and repolarization times and repolarization time dispersion derived from the root-mean-square (RMS) of the ECG for each beat, dynamic tracking and modeling of repolarization rate dependency, RR interval dispersion dynamics assessment based on Poincare scatter plots, and a new method of quantizing dynamically TWA in Holter recordings. Examples of measurements and analyses of Holter recordings from patients with episodes of ventricular tachycardia will be presented.