Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction

doi:10.1016/j.jacc.2005.11.026

PMID: 16412877DOI: 10.1016/j.jacc.2005.11.026Jan 18, 2006

Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction

Journal of the American College of Cardiology

Daniel M BloomfieldJohn Fontaine

Abstract

This study hypothesized that microvolt T-wave alternans (MTWA) improves selection of patients for implantable cardioverter-defibrillator (ICD) prophylaxis, especially by identifying patients who are not likely to benefit. Many patients with left ventricular dysfunction are now eligible for prophylactic ICDs, but most eligible patients do not benefit; MTWA testing has been proposed to improve patient selection. Our study was conducted at 11 clinical centers in the U.S. Patients were eligible if they had a left ventricular ejection fraction (LVEF) < or =0.40 and lacked a history of sustained ventricular arrhythmias; patients were excluded for atrial fibrillation, unstable coronary artery disease, or New York Heart Association functional class IV heart failure. Participants underwent an MTWA test and then were followed for about two years. The primary outcome was all-cause mortality or non-fatal sustained ventricular arrhythmias. Ischemic heart disease was present in 49%, mean LVEF was 0.25, and 66% had an abnormal MTWA test. During 20 +/- 6 months of follow-up, 51 end points (40 deaths and 11 non-fatal sustained ventricular arrhythmias) occurred. Comparing patients with normal and abnormal MTWA tests, the hazard ratio for the pri...Continue Reading

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Feb 20, 2015·Herzschrittmachertherapie & Elektrophysiologie·Thomas Klingenheben

Effects of exercise rehabilitation on cardiac electrical instability assessed by T-wave alternans during ambulatory electrocardiogram monitoring in coronary artery disease patients without and with diabetes mellitus

Aug 12, 2014·The American Journal of Cardiology·Tuomas KenttäRichard L Verrier

Therapy for ventricular arrhythmias in structural heart disease: a multifaceted challenge

Dec 2, 2015·The Journal of Physiology·Riccardo ProiettiVidal Essebag

How computer simulations of the human heart can improve anti-arrhythmia therapy

Dec 2, 2015·The Journal of Physiology·Natalia A Trayanova, Kelly C Chang

A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain

Jun 12, 2016·Critical Care : the Official Journal of the Critical Care Forum·Micah Liam Arthur HeldewegMarcus Eng Hock Ong

Microvolt T-wave alternans amplifies spatial dispersion of repolarization in human subjects with ischemic cardiomyopathy

Jun 28, 2016·Journal of Electrocardiology·Tilak PasalaElizabeth S Kaufman

Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators

Jul 29, 2016·International Journal of Cardiology·Marco Paulo Tomaz BarbosaAntonio Luiz Pinho Ribeiro

Does manual T-wave window adjustment affect microvolt T-wave alternans results in patients with structural heart disease?

Sep 7, 2016·Journal of Electrocardiology·Tharmathai RamananElizabeth S Kaufman

Impaired exercise capacity predicts sudden cardiac death in a low-risk population: enhanced specificity with heightened T-wave alternans

Mar 21, 2009·Annals of Medicine·Mikko MinkkinenMika Kähönen

Predictors of poor outcome in patients with pulmonary arterial hypertension: A single center study

Apr 24, 2018·PloS One·Emilia StepnowskaGrzegorz Raczak

Microvolt T-wave alternans and autonomic nervous system parameters can be helpful in the identification of low-arrhythmic risk patients with ischemic left ventricular systolic dysfunction

May 4, 2018·PloS One·Ludmiła Daniłowicz-SzymanowiczGrzegorz Raczak

Relationship between early diastolic dysfunction and abnormal microvolt T-wave alternans in patients with type 2 diabetes

Apr 20, 2011·Circulation. Cardiovascular Imaging·Stefano BonapaceEnrico Barbieri

From pulsus to pulseless: the saga of cardiac alternans

May 27, 2006·Circulation Research·James N WeissZhilin Qu

Three-dimensional impulse propagation in myocardium: arrhythmogenic mechanisms at the tissue level

Mar 2, 2013·Circulation Research·Bruce H SmaillMark L Trew

Is microvolt T-wave alternans the answer to risk stratification in heart failure?

Dec 19, 2007·Circulation·Rachel C MylesStuart M Cobbe

Early repolarization associated with ventricular arrhythmias in patients with chronic coronary artery disease

Jul 27, 2010·Circulation. Arrhythmia and Electrophysiology·Ravi B PatelAlan H Kadish

ACC/AHA/ESC 2006 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 (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart

Aug 29, 2006·Circulation·Douglas P ZipesHeart Rhythm Society

T-wave alternans in the sudden cardiac death in heart failure trial population: signal or noise?

Nov 13, 2008·Circulation·David S Rosenbaum

Structural heterogeneity alone is a sufficient substrate for dynamic instability and altered restitution

Feb 6, 2010·Circulation. Arrhythmia and Electrophysiology·Zoar J EngelmanBruce H Smaill

Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)

Aug 30, 2008·Circulation·Virend K SomersAmerican College of Cardiology Foundation

Sudden death secondary to cardiac arrhythmias: mechanisms and treatment strategies

Aug 11, 2006·Current Opinion in Cardiology·Adnan Siddiqui, Peter R Kowey

Utility of microvolt T-wave alternans to predict sudden cardiac death in patients with cardiomyopathy

Dec 5, 2006·Current Opinion in Cardiology·Vijay S Chauhan, Raja J Selvaraj

Innovations in cardiac nursing and technology

Jan 9, 2007·Nursing Management·Kathleen Hudson

Microvolt T-wave alternans during atrial and ventricular pacing

Feb 17, 2007·Pacing and Clinical Electrophysiology : PACE·Alaa A ShalabyVladimir Shusterman

T-wave alternans and sudden cardiac death

May 7, 2008·Critical Pathways in Cardiology·Ayman El-Menyar, Nidal Asaad

Implantable cardioverter defibrillator therapy for patients with less severe left ventricular dysfunction

Dec 17, 2008·Current Opinion in Cardiology·Derek V Exner

Acute volume overload elevates T-wave alternans magnitude

Dec 13, 2006·Journal of Applied Physiology·Sanjiv M NarayanCarl F Edman

Steeper restitution slopes across right ventricular endocardium in patients with cardiomyopathy at high risk of ventricular arrhythmias

Nov 14, 2006·American Journal of Physiology. Heart and Circulatory Physiology·Raja J SelvarajVijay S Chauhan

Indeterminacy of spatiotemporal cardiac alternans

Sep 4, 2008·Physical Review. E, Statistical, Nonlinear, and Soft Matter Physics·Xiaopeng Zhao

Microvolt T-wave alternans testing for ventricular arrhythmia risk stratification

Jun 24, 2008·Expert Review of Cardiovascular Therapy·Theodore Chow, Deepak Joshi

A multichannel decision-level fusion method for T wave alternans detection

Oct 2, 2017·The Review of Scientific Instruments·Changrong YeXichuan Zhou

Use of T-wave alternans in identifying patients with coronary artery disease

Apr 16, 2014·Journal of Cardiovascular Medicine·Stefano FigliozziFilippo Crea

Microvolt QRS Alternans Without Microvolt T-Wave Alternans in Human Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias.

Aug 19, 2020·Journal of the American Heart Association·Adrian SuszkoVijay S Chauhan

Mechanisms of calcium transient and action potential alternans in cardiac cells and tissues

Oct 24, 2007·American Journal of Physiology. Heart and Circulatory Physiology·William T Clusin

Predictive value of microvolt T-wave alternans for cardiac death or ventricular tachyarrhythmic events in ischemic and nonischemic cardiomyopathy patients: a meta-analysis

Oct 20, 2011·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Leonardo CalòErnesto Lioy

Memory effects, transient growth, and wave breakup in a model of paced atrium

Oct 2, 2017·Chaos·Alejandro Garzón, Roman O Grigoriev

LifeMap: towards the development of a new technology in sudden cardiac death risk stratification for clinical use

Apr 24, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Ghulam André NgWilliam B Nicolson

A translational approach to probe the proarrhythmic potential of cardiac alternans: a reversible overture to arrhythmogenesis?

Dec 11, 2013·American Journal of Physiology. Heart and Circulatory Physiology·Faisal M MerchantAntonis A Armoundas

The clinical value of T-wave alternans derived from Holter monitoring

Jan 1, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Joanna LewekIwona Cygankiewicz

Primary Prevention ICD Therapy in Heart Failure with Recovered Ejection Fraction.

Feb 27, 2021·Journal of Cardiac Failure·Jayson R BamanJane E Wilcox

Related Concepts

Cardiac Arrhythmia

Electrocardiographic Recorders

Implantable Defibrillator

Ventricular Dysfunction, Left

Benefit-Risk Assessment

Selection of Subjects

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