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T wave alternans for ventricular arrhythmia risk stratification.
Michael R Gold1, William Spencer
1Department of Medicine, Division of Cardiology, Medical University of South Carolina, 135 Rutledge Avenue, Rutledge Towers Suite 1201, Charleston, SC 29425, USA. goldmr@musc.edu
Current Opinion in Cardiology
|December 24, 2002
Summary
T wave alternans (TWA) effectively identifies patients at risk for sudden cardiac death. This heart rate-dependent measure of arrhythmia vulnerability shows promise for guiding clinical therapy in diverse patient groups.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Sudden cardiac death (SCD) is a significant cause of mortality in Western societies.
- Identifying high-risk individuals is crucial for efficient therapeutic interventions.
- T wave alternans (TWA) is an emerging non-invasive test for SCD risk stratification.
Purpose of the Study:
- To evaluate the role of T wave alternans (TWA) in predicting sudden cardiac death risk.
- To assess the clinical utility of TWA across various patient populations.
Main Methods:
- T wave alternans (TWA) measurement, a heart rate-dependent assessment of arrhythmia vulnerability.
- Maximal predictive accuracy achieved at sustained heart rates of 100-120 bpm, using exercise or atrial pacing.
- Application in diverse patient cohorts including coronary artery disease, cardiomyopathy, heart failure, and those with implantable defibrillators.
Main Results:
- TWA demonstrated predictive accuracy for ventricular tachycardia inducibility via programmed stimulation.
- TWA successfully predicted spontaneous arrhythmic events.
- The test has been applied effectively across multiple cardiovascular conditions.
Conclusions:
- T wave alternans (TWA) shows significant promise as a tool for risk stratification of sudden cardiac death.
- Further research is needed to fully elucidate the role of TWA in guiding clinical management and therapy.