Prognostic Utility of Microvolt T-Wave Alternans in Risk Stratification of Patients With Ischemic Cardiomyopathy

Abstract

Microvolt T-wave alternans is a strong and independent predictor of all-cause and arrhythmic mortality in patients with ischemic cardiomyopathy.

A Multilead Scheme Based on Periodic Component Analysis for T-Wave Alternans Analysis in the ECG

“…19,23 TWA has been shown to reflect the presence of abnormal repolarization and electrophysiologic inhomogeneities that underlie vulnerability to ventricular fibrillation. 19 Measurement of TWA during controlled heart rate elevation is considered as a potentially useful predictor of ventricular arrhythmic events and mortality in patients with ischemic cardiomyopathy, 3 and its role in identification of patients that would benefit ICD implantation is being currently studied. 6 TWA amplitudes are in the range of microvolts, and can be even below the noise level, making the detection of TWA a difficult task.…”

Definition, Diagnosis and Treatment of Tachycardia

“…Reduced left ventricular function, inducibility of sustained VT during electrophysiologic study, T wave alternans are some of the strong predictors of poor outcome in patients with VT (11).…”

Evidence regarding clinical use of microvolt T-wave alternans

“…Approximately one-third of the symptomatic patients with LVEF ≤ 0.35 may test MTWA negative 7,12 . However, a non-negative test in the remaining patients may serve as a specific call to action for the patient and referring Stecker et al 31 found that LVEF had been measured in only 17% of 714 cases of SCD.…”

“…As a result, a number of recent clinical trials conducted to evaluate MTWA testing have involved patients with prophylactically implanted ICDs [11][12][13][14][15] . Such trials have generally utilized appropriate ICD therapy (AICDT) as the predominant component of the VTE endpoint.…”