BlueCross BlueShield of Tennessee Medical Policy Manual

Signal Averaged Electrocardiography (SAECG)


Signal-averaged electrocardiography (SAECG) has been proposed as a tests to predict which individuals are at highest risk of experiencing an arrhythmic event (either a sustained arrhythmia or sudden cardiac death). Because sudden cardiac death, whether from arrhythmias or pump failure, is one of the most common causes of death after a previous myocardial infarction, there is intense interest in risk stratification to determine target therapy. SAECG involves computerized analysis of small segments of a standard ECG to detect abnormalities. Signals are first amplified, then filtered, and finally averaged with the assistance of computer software. 




The available literature does not validate the use of SAECG for predicting which individuals are at highest risk of experiencing an arrhythmic event. No trials were found in which use of SAECG was shown to improve outcomes.


American College of Cardiology/American Heart Association Task Force on Practice Guidelines (2014) 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease. Retrieved October 4, 2017 from

Jongman, J. K., Zaidi, A., Muggenthaler, M. & Sharma, S. (2015). Relationship between echocardiographic right-ventricular dimensions and signal-averaged electrocardiogram abnormalities in endurance athletes. Europace, 17 (9), 1441-1448. Abstract retrieved November 7, 2016 from PubMed database.

Kanzaki, Y., Inden, Y., Ando, M., Kamikubo, Y., Ito, T., Mizutani, Y., et al. (2016, November) An ECG index of P-wave force predicts the recurrence of atrial fibrillation after pulmonary vein isolation. Pacing Clinical Electrophysiology, 39 (11), 1191-1197. Abstract retrieved October 4, 2017 from PubMed database.

Kutarski, A., Glowniak, A., Szczesniak, D., & Rucinski, P. (2008). Effects of different atrial pacing modes evaluated by intracardiac signal-averaged ECG. Cardiology Journal, 15 (2), 129-142. (Level 5 evidence - Independent)

Mendes, V. N., Pereira, T. S., & Matos, V. A. (2016). Diagnosis of rejection by analyzing ventricular late potentials in heart transplant patients. Arquivos Brasileiros de Cardiologia, 106 (2), 136-144. Abstract retrieved November 7, 2016 from PubMed database.

Pandey, A. K.., Das, A., Singwala, A. K. & Bhatt, K. N. (2010). Prediction and stratification of the future cardiovascular arrhythmic events: signal averaged electrocardiography versus ejection fraction. Indian Journal of Physiology and Pharmacology, 54 (2), 123-132. Abstract retrieved December 3, 2015 from PubMed database.

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. (Level 4 evidence - Independent)

Yodogawa, K., Seino, Y., Ohara, T., Hayashi, M., Miyauchi, Y., Katoh, T., et al. (2013). Prediction of atrial fibrillation after ischemic stroke using P-wave signal averaged electrocardiography. Journal of Cardiology, 61 (1), 49-52. Abstract retrieved November 7, 2016 from PubMed database.




Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.