Temporal and postural variation of 12-lead high-frequency QRS electrocardiographic signals in asymptomatic individuals

Because changes in the 12-lead high-frequency QRS electrocardiogram (HF QRS ECG) more sensitively identify myocardial ischemia than do changes in the ST segments of the conventional ECG, it is important that changes in HF QRS signals that are merely physiological be distinguishable from those that are potentially pathological. We therefore studied the temporal variation of HF QRS measures such as root mean square (RMS) voltage and the presence vs absence of reduced amplitude zones (RAZs) in 107 asymptomatic individuals in the supine position during a brief period of ECG monitoring. In addition, to ascertain the effects of posture on the 12-lead HF QRS ECG, we collected additional seated data from 25 of these individuals and estimated the fifth and 95th percentile of the percent relative change between the supine and seated measurements. In all cases, variation of HF QRS parameters decreased as the number of beats in the signal average increased. For example, in the supine position, the 95th percentile of the percent relative change between consecutive within-lead measurements of RMS voltage for a 50-beat signal average was 12.3% but decreased to 11.7%, 11.2%, and 10.7% for 75, 100, and 150 beat signal averages, respectively (P < .01). After transition from the supine to the seated upright position, changes in some measures of HF QRS were statistically significant, with RMS voltage decreasing significantly in lead V3 and with the number of RAZs lost in the 12-lead HF QRS ECG significantly exceeding the number of RAZs gained. We conclude that most measures of HF QRS ECG are sufficiently stable for routine continuous monitoring.