Signal Averaged Electrocardiography (SAECG)
DESCRIPTION
Signal-averaged electrocardiography (SAECG) is one of the tests used to predict which individuals are at highest risk of experiencing an arrhythmic event (either a sustained arrhythmia or sudden cardiac death). SAECG is a modification of conventional ECG recordings in which signals are first amplified, then filtered, and finally averaged with the assistance of computer software.
POLICY
Signal-averaged electrocardiography is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The literature reviewed including cohort and case studies does not validate the use of SAECG for predicting which individuals are at highest risk of experiencing an arrhythmic event. No trials were found where prospective use of SAECG was shown to improve the outcomes.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2010). Signal-Averaged Electrocardiography (2.02.04). Retrieved November 17, 2011 from BlueWeb. (17 articles and/or guidelines reviewed)
Hunt, S. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., et al. (2009). Focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults. A report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Retrieved November 18, 2011 from http://www.guideline.gov.
Kutarski, A., Glowniak, A., Szczesniak, D., and, Rucinski, P., (2008). Effects of different atrial pacing modes evaluated by intracardiac signal-averaged ECG. Cardiology Journal, 15(2), 129-142.
Schoenenberger, A., Erne, P., Ammann, S., Gillmann, G., Kobza, R., Stuck, A. (2008). Prediction of arrhythmic events after myocardial infarction based on signal-averaged electrocardiogram and ejection fraction. Pacing Clinical Electrophysiology, 31 (2), 221-228.
Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., et al. (2006). ACC/AHA/ESC guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for practice guidelines. Retrieved November 18, 2011 from http://www.guideline.gov.
ORIGINAL EFFECTIVE DATE: 7/1986
MOST RECENT REVIEW DATE: 1/12/2012
ID_BA
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