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Predictive value of microvolt T-wave alternans in patients with left ventricular dysfunction
Daniel J Cantillon1, Kenneth M Stein, Steven M Markowitz
1Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York 10021, USA.
Microvolt T-wave alternans (TWA) predicts arrhythmia-free survival in patients with left ventricular dysfunction. However, it may not identify a low-risk group sufficient to avoid implantable cardioverter-defibrillator (ICD) implantation.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Microvolt T-wave alternans (TWA) is a proposed tool for identifying patients unlikely to benefit from implantable cardioverter-defibrillator (ICD) prophylaxis.
- Left ventricular (LV) dysfunction is a significant risk factor for arrhythmias.
Purpose of the Study:
- To prospectively evaluate the utility of microvolt T-wave alternans (TWA) in predicting arrhythmia-free survival and total mortality in patients with LV dysfunction.
Main Methods:
- 286 patients with LV ejection fraction ≤35% underwent TWA and electrophysiologic testing (EPS).
- Patients were followed for a mean of 38 months.
- Positive and indeterminate TWA results were grouped as non-negative.
Main Results:
- TWA-negative patients demonstrated improved arrhythmia-free survival (81% vs. 66% at 2 years, p < 0.001) and lower total mortality (10% vs. 18% at 2 years, p = 0.04).
- The negative predictive value of TWA for 2-year total mortality was 90%.
- No significant difference in ICD implant rates was observed between TWA-negative and non-negative groups.
Conclusions:
- Microvolt TWA effectively predicts arrhythmia-free survival in patients with LV dysfunction.
- The event rate in the TWA-negative group indicates that TWA alone may not be sufficient to rule out the need for ICD implantation in this population.
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