Skip to main content
Top
Gepubliceerd in: Netherlands Heart Journal 1/2011

01-01-2011 | Original Article

Is T-Wave Alternans Testing Feasible in Candidates for Prophylactic Implantable Defibrillators?

Auteurs: K. Kraaier, T. McCracken, J. van der Palen, A. A. M. Wilde, M. F. Scholten

Gepubliceerd in: Netherlands Heart Journal | Uitgave 1/2011

Log in om toegang te krijgen
share
DELEN

Deel dit onderdeel of sectie (kopieer de link)

  • Optie A:
    Klik op de rechtermuisknop op de link en selecteer de optie “linkadres kopiëren”
  • Optie B:
    Deel de link per e-mail

Abstract

Aims

Previous studies have demonstrated that microvolt T-wave alternans (TWA) screening in patients with ischaemic and dilated cardiomyopathy is effective in identifying patients at high or low risk of sudden cardiac death. It remains unclear which percentage of potential recipients of an implantable cardioverter defibrillator (ICD) are able to perform TWA testing using an exercise protocol which is, at this moment, the golden standard. In this study, we evaluated the feasibility of TWA in the risk stratification of potential ICD recipients with ischaemic or dilated cardiomyopathy.

Methods and Results

Medical charts of 165 primary prevention ICD recipients were reviewed to decide if patients were able to perform a TWA exercise test or not. Reasons to waiver a test were: atrial fibrillation or flutter, pacemaker dependency, recent (cardiovascular) surgery (<1 month) and inability to exercise. Of the potential ICD recipients 35% had one or more of these contraindications and were therefore not suitable for testing.

Conclusion

In several studies, TWA is a promising risk stratifier for predicting sudden cardiac death; however, in our population, 35% of the potential ICD candidates could not be tested. In order to fulfil its promise as a predictor for SCD, an alternative means to measure TWA needs to be evaluated.
Literatuur
1.
go back to reference Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98(21):2334–51.PubMed Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98(21):2334–51.PubMed
2.
go back to reference Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators. N Engl J Med. 1996;335(26):1933–40.PubMedCrossRef Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter automatic defibrillator implantation trial investigators. N Engl J Med. 1996;335(26):1933–40.PubMedCrossRef
3.
go back to reference Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter–defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.PubMedCrossRef Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter–defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.PubMedCrossRef
4.
go back to reference Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis. J Am Coll Cardiol. 2005;46(1):75–82.PubMedCrossRef Gehi AK, Stein RH, Metz LD, Gomes JA. Microvolt T-wave alternans for the risk stratification of ventricular tachyarrhythmic events: a meta-analysis. J Am Coll Cardiol. 2005;46(1):75–82.PubMedCrossRef
5.
go back to reference Chow T, Kereiakes DJ, Onufer J, Woelfel A, Gursoy S, Peterson BJ, et al. Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial. J Am Coll Cardiol. 2008;52(20):1607–15.PubMedCrossRef Chow T, Kereiakes DJ, Onufer J, Woelfel A, Gursoy S, Peterson BJ, et al. Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial. J Am Coll Cardiol. 2008;52(20):1607–15.PubMedCrossRef
6.
go back to reference Gold MR, Ip JH, Costantini O, Poole JE, McNulty S, Mark DB, et al. Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy. Circulation. 2008;118(20):2022–8.PubMedCrossRef Gold MR, Ip JH, Costantini O, Poole JE, McNulty S, Mark DB, et al. Role of microvolt T-wave alternans in assessment of arrhythmia vulnerability among patients with heart failure and systolic dysfunction: primary results from the T-wave alternans sudden cardiac death in heart failure trial substudy. Circulation. 2008;118(20):2022–8.PubMedCrossRef
7.
go back to reference Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. 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 Rhythm Society. Europace. 2006;8(9):746–837.PubMedCrossRef Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. 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 Rhythm Society. Europace. 2006;8(9):746–837.PubMedCrossRef
8.
go back to reference Narayan SM. T-wave alternans and the susceptibility to ventricular arrhythmias. J Am Coll Cardiol. 2006;47(2):269–81.PubMedCrossRef Narayan SM. T-wave alternans and the susceptibility to ventricular arrhythmias. J Am Coll Cardiol. 2006;47(2):269–81.PubMedCrossRef
9.
go back to reference Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96(1):345–54.PubMed Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, et al. ACC/AHA guidelines for exercise testing: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 1997;96(1):345–54.PubMed
10.
go back to reference Haghjoo M, Arya A, Sadr-Ameli MA. Microvolt T-wave alternans: a review of techniques, interpretation, utility, clinical studies, and future perspectives. Int J Cardiol. 2006;109(3):293–306.PubMedCrossRef Haghjoo M, Arya A, Sadr-Ameli MA. Microvolt T-wave alternans: a review of techniques, interpretation, utility, clinical studies, and future perspectives. Int J Cardiol. 2006;109(3):293–306.PubMedCrossRef
11.
go back to reference Raatikainen MJ, Jokinen V, Virtanen V, Hartikainen J, Hedman A, Huikuri HV. Microvolt T-wave alternans during exercise and pacing in patients with acute myocardial infarction. Pacing Clin Electrophysiol. 2005;28 Suppl 1:S193–7.PubMedCrossRef Raatikainen MJ, Jokinen V, Virtanen V, Hartikainen J, Hedman A, Huikuri HV. Microvolt T-wave alternans during exercise and pacing in patients with acute myocardial infarction. Pacing Clin Electrophysiol. 2005;28 Suppl 1:S193–7.PubMedCrossRef
12.
go back to reference Hohnloser SH, Klingenheben T, Zabel M, Li YG, Albrecht P, Cohen RJ. T wave alternans during exercise and atrial pacing in humans. J Cardiovasc Electrophysiol. 1997;8(9):987–93.PubMedCrossRef Hohnloser SH, Klingenheben T, Zabel M, Li YG, Albrecht P, Cohen RJ. T wave alternans during exercise and atrial pacing in humans. J Cardiovasc Electrophysiol. 1997;8(9):987–93.PubMedCrossRef
13.
go back to reference Rashba EJ, Osman AF, Macmurdy K, Kirk MM, Sarang S, Peters RW, et al. Exercise is superior to pacing for T-wave alternans measurement in subjects with chronic coronary artery disease and left ventricular dysfunction. J Cardiovasc Electrophysiol. 2002;13(9):845–50.PubMedCrossRef Rashba EJ, Osman AF, Macmurdy K, Kirk MM, Sarang S, Peters RW, et al. Exercise is superior to pacing for T-wave alternans measurement in subjects with chronic coronary artery disease and left ventricular dysfunction. J Cardiovasc Electrophysiol. 2002;13(9):845–50.PubMedCrossRef
14.
go back to reference Kraaier K, Verhorst PM, van der Palen J, van Dessel PF, Wilde AA, Scholten MF. Microvolt T-wave alternans during exercise and pacing are not comparable. Europace. 2009;11(10):1375–80.PubMedCrossRef Kraaier K, Verhorst PM, van der Palen J, van Dessel PF, Wilde AA, Scholten MF. Microvolt T-wave alternans during exercise and pacing are not comparable. Europace. 2009;11(10):1375–80.PubMedCrossRef
15.
go back to reference Zipes DP, Jalife J. Cardiac electrophysiology. From cell to bedside, 3 ed. WB Saunders: New York, 2000. Zipes DP, Jalife J. Cardiac electrophysiology. From cell to bedside, 3 ed. WB Saunders: New York, 2000.
16.
go back to reference Weber S, Schwab JO. Comparison of microvolt T-wave alternans measurements using atrial pacing compared to atropine administration. Pacing Clin Electrophysiol. 2007;30(12):1487–92.PubMedCrossRef Weber S, Schwab JO. Comparison of microvolt T-wave alternans measurements using atrial pacing compared to atropine administration. Pacing Clin Electrophysiol. 2007;30(12):1487–92.PubMedCrossRef
17.
go back to reference Nearing BD, Verrier RL. Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol. 2002;92(2):541–9.PubMed Nearing BD, Verrier RL. Modified moving average analysis of T-wave alternans to predict ventricular fibrillation with high accuracy. J Appl Physiol. 2002;92(2):541–9.PubMed
18.
go back to reference Sakaki K, Ikeda T, Miwa Y, Miyakoshi M, Abe A, Tsukada T, et al. Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study. Heart Rhythm. 2009;6(3):332–7.PubMedCrossRef Sakaki K, Ikeda T, Miwa Y, Miyakoshi M, Abe A, Tsukada T, et al. Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study. Heart Rhythm. 2009;6(3):332–7.PubMedCrossRef
Metagegevens
Titel
Is T-Wave Alternans Testing Feasible in Candidates for Prophylactic Implantable Defibrillators?
Auteurs
K. Kraaier
T. McCracken
J. van der Palen
A. A. M. Wilde
M. F. Scholten
Publicatiedatum
01-01-2011
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 1/2011
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-010-0053-5

Andere artikelen Uitgave 1/2011

Netherlands Heart Journal 1/2011 Naar de uitgave