Predictive value of microvolt T-Wave alternans in patients with left ventricular dysfunction

Cantillon, Daniel J., Stein, Kenneth M., Markowitz, Steven M., Mittal, Suneet, Shah, Bindi K., Morin, Daniel P., Zacks, Eran S., Janik, Matthew, Ageno, Shaun, Mauer, Andreas C., Lerman, Bruce B. and Iwai, Sei (2007) Predictive value of microvolt T-Wave alternans in patients with left ventricular dysfunction. Journal of the American College of Cardiology, 50 2: 166-173. doi:10.1016/j.jacc.2007.02.069

Author Cantillon, Daniel J.
Stein, Kenneth M.
Markowitz, Steven M.
Mittal, Suneet
Shah, Bindi K.
Morin, Daniel P.
Zacks, Eran S.
Janik, Matthew
Ageno, Shaun
Mauer, Andreas C.
Lerman, Bruce B.
Iwai, Sei
Title Predictive value of microvolt T-Wave alternans in patients with left ventricular dysfunction
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
Publication date 2007-07
Sub-type Article (original research)
DOI 10.1016/j.jacc.2007.02.069
Volume 50
Issue 2
Start page 166
End page 173
Total pages 8
Place of publication San Diego, CA, United States
Publisher Elsevier Inc.
Language eng
Formatted abstract
Objectives: The purpose of this study was to prospectively evaluate the utility of microvolt T-wave alternans (TWA) in predicting arrhythmia-free survival and total mortality in patients with left ventricular (LV) dysfunction. Background: Microvolt TWA has been proposed as a useful tool in identifying patients unlikely to benefit from prophylaxis with implantable cardioverter-defibrillator (ICD) prophylaxis. Methods: We evaluated 286 patients with an LV ejection fraction ≤35% who underwent TWA and electrophysiologic testing (EPS) owing to nonsustained ventricular tachycardia and/or syncope. Positive and indeterminate TWA results were grouped as non-negative. The primary end point was arrhythmia-free survival; the secondary end point was all-cause mortality. Results: Patients were followed for a mean of 38 ± 11 months. There was no significant difference between the TWA-negative (n = 90; 31%) and non-negative (n = 196; 69%) groups with respect to ICD implant rates (54% vs. 64%, respectively; p = 0.95) or etiology of cardiomyopathy (ischemic: 73% vs. 76%; p = 0.71). The Kaplan-Meier curves demonstrated improved arrhythmia-free survival in TWA-negative patients (81% vs. 66% at 2 years; p < 0.001), including in both ischemic (79% vs. 64% at 2 years; p = 0.004) and nonischemic (88% vs. 71% at 2 years; p = 0.015) subgroups. Total mortality was lower in the TWA-negative group (10% vs. 18% at 2 years; p = 0.04). The negative predictive value of TWA for (2-year) total mortality was 90%, and 83% for EPS. Conclusion: Microvolt TWA predicts arrhythmia-free survival among patients with LV dysfunction. However, the event rate in the TWA-negative group suggests that TWA may not be capable of identifying a sufficiently low-risk subset in this population to obviate the need for ICD implantation. © 2007 American College of Cardiology Foundation.
Keyword Implantable Cardioverter-Defibrillator
Risk Stratification
Ejection Fraction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
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