Effect of oral beta-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy

Zacks, Erin S., Morin, Daniel P., Ageno, Shaun, Janik, Matthew, Mauer, Andreas C., Markowitz, Steven M., Mittal, Suneet, Iwai, Sei, Shah, Bindi K., Lerman, Bruce B. and Stein, Kenneth M. (2007) Effect of oral beta-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy. American Heart Journal, 153 3: 392-397. doi:10.1016/j.ahj.2006.12.010


Author Zacks, Erin S.
Morin, Daniel P.
Ageno, Shaun
Janik, Matthew
Mauer, Andreas C.
Markowitz, Steven M.
Mittal, Suneet
Iwai, Sei
Shah, Bindi K.
Lerman, Bruce B.
Stein, Kenneth M.
Title Effect of oral beta-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
1097-6744
Publication date 2007-03
Sub-type Article (original research)
DOI 10.1016/j.ahj.2006.12.010
Volume 153
Issue 3
Start page 392
End page 397
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Mosby
Language eng
Formatted abstract
Background Prior investigation has shown that intravenous β-blockers decrease T-wave alternans (TWA) positivity in patients undergoing electrophysiology study (EPS). The present study examined whether oral β-blocker use within 24 hours of TWA influences yield and predictive value of TWA and EPS.

Methods We prospectively evaluated 387 patients (312 [81%] men, mean age 67 +/- 11 years) with coronary artery disease, left ventricular ejection fraction <= 40%, and nonsustained ventricular tachycardia who underwent EPS and were followed for a mean of 2.8 +/- 1.4 years. T-Wave alternans was performed using an atrial pacing protocol and interpreted using standard criteria. β-Blocker status was determined based on oral beta-blocker use in the 24 hours preceding the test: beta-blocker (-) (n = 62), β-blocker (+) (n = 325). Follow-up for ventricular tachycardia, ventricular fibrillation, and death was obtained from chart review, device interrogation, and the Social Security Death Index. Estimated sensitivity and specificity of TWA and EPS stratified by β-blocker use were calculated based on event-free 2-year survival.

Results There was no difference in EPS (31 [50%] inducible off β-blockers vs 166 [51%] on β-blockers [P = .891) or TWA (26 [42%] positive, 17 [27%] indeterminate off β-blockers vs 136 [42%] positive, 81 [25%] indeterminate on -blockers [P =.89]). β-Blocker use within 24 hours of testing did not affect the predictive value of TWA or EPS for overall or 2-year event-free survival.

Conclusions
Oral β-blocker therapy appears to have no effect on yield or predictive value of EPS or TWA in patients with coronary artery disease, diminished left ventricular function, and a history of nonsustained ventricular tachycardia.
Keyword Implantable cardloverter-defibrillators
Sustained ventricular-arrhythmias
Congestive-heart-failure
Sudden cardiac death
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Erratum: American Heart Journal Volume: 153 Issue: 5 Pages: 836-836 Published: May 2007 There were 3 articles appearing in the March 2007 issue of the Journal that were published under incorrect headings. The article “Burzotta F, Romagnoli E, Manzoli A, et al. The Outcome for PCI for stent-Thrombosis Multicentre Study (OPTIMIST): Rationale and design of a multicenter registry. Am Heart J 2007;153:377.e1-377.e5” should have appeared in the “Trial Design” section. The article “Olson TP, Snyder EM, Frantz RP, et al. Repeat length polymorphism of the serotonin transporter gene influences pulmonary artery pressure in heart failure. Am Heart J 2007;153:426-32” should have appeared in the “Clinical Investigations” section under the “Genetics” subsection. The article “Zacks ES, Morin DP, Ageno S, et al. Effect of oral ß-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy. Am Heart J 2007;153:392-7” should have appeared in the “Clinical Investigations” section under the “Electrophysiology” subsection. The publisher apologizes for these errors and any inconvenience this has caused.

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