High-frequency ECG

The standard ECG is by convention limited to 0.05-150 Hz, but higher frequencies are also present in the ECG signal. With high-resolution technology, it is possible to record and analyze these higher frequencies. The highest amplitudes of the high-frequency components are found within the QRS complex. In past years, the term "high frequency", "high fidelity", and "wideband electrocardiography" have been used by several investigators to refer to the process of recording ECGs with an extended bandwidth of up to 1000 Hz. Several investigators have tried to analyze HF-QRS with the hope that additional features seen in the QRS complex would provide information enhancing the diagnostic value of the ECG. The development of computerized ECG-recording devices that made it possible to record ECG signals with high resolution in both time and amplitude, as well as better possibilities to store and process the signals digitally, offered new methods for analysis. Different techniques to extract the HF-QRS have been described. Several bandwidths and filter types have been applied for the extraction as well as different signal-averaging techniques for noise reduction. There is no standard method for acquiring and quantifying HF-QRS. The physiological mechanisms underlying HF-QRS are still not fully understood. One theory is that HF-QRS are related to the conduction velocity and the fragmentation of the depolarization wave in the myocardium. In a three-dimensional model of the ventricles with a fractal conduction system it was shown that high numbers of splitting branches are associated with HF-QRS. In this experiment, it was also shown that the changes seen in HF-QRS in patients with myocardial ischemia might be due to the slowing of the conduction velocity in the region of ischemia. This mechanism has been tested by Watanabe et al by infusing sodium channel blockers into the left anterior descending artery in dogs. In their study, 60 unipolar ECGs were recorded from the entire ventricular surface and were signal-averaged and filtered in the 30-250 Hz frequency range. The results showed that the decrease noted in the HF-QRS correlated linearly with the local conduction delay. The results suggest that HF-QRS is a potent indicator of disturbed local conduction. An alternative theory is that HF-QRS reflect the shape of the original electrocardiographic signal. Bennhagen et al showed that root mean square (RMS) voltage values of the depolarization signal correlate poorly with the signal amplitude but highly with the first and second derivatives, i.e. the velocity and the acceleration of the signal. It has also been suggested that the autonomic nervous system affects HF-QRS. For example, sitting up causes significant changes in HF-QRS in some leads compared to the supine position [Douglas et al., 2006]. Unpublished results indicate that familial dysautonomic patients (both vagal and sympathetic degeneration) have very little Reduced Amplitude Zones (RAZ) formation . Athletic individuals, especially elite athletes, who have vagally-mediated changes on the conventional ECG (i.e. early repolarization, bradycardia) have increased RAZ formation. Further electrophysiological studies are needed, however, to better understand the underlying mechanisms of HF-QRS. Several investigators have studied HF-QRS in different cardiac conditions, including acute myocardial ischemia and myocardial infarction (MI). However, in order for clinicians to confidently use HF-QRS as an adjunct to standard ECG, more knowledge about the characteristics of HF-QRS is needed.