Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death

Faisal M. Merchant, Takanori Ikeda, Roberto F E Pedretti, Jorge A. Salerno-Uriarte, Theodore Chow, Paul S. Chan, Cheryl Bartone, Stefan H. Hohnloser, Richard J. Cohen, Antonis A. Armoundas

Research output: Contribution to journalArticle

Abstract

Background: Previous studies have demonstrated that microvolt T-wave alternans (MTWA) testing is a robust predictor of ventricular tachyarrhythmias and sudden cardiac death (SCD) in at-risk patients. However, recent studies have suggested that MTWA testing is not as good a predictor of " appropriate" implantable cardioverter-defibrillator (ICD) therapy as it is a predictor of SCD in patients without ICDs. Objective: To evaluate the utility of MTWA testing for SCD risk stratification in patients without ICDs. Methods: Patient-level data were obtained from 5 prospective studies of MTWA testing in patients with no history of ventricular arrhythmia or SCD. In these studies, ICDs were implanted in only a minority of patients and patients with ICDs were excluded from the analysis. We conducted a pooled analysis and examined the 2-year risk for SCD based on the MTWA test result. Results: The pooled cohort included 2883 patients. MTWA testing was positive in 856 (30%), negative in 1627 (56%), and indeterminate in 400 (14%) patients. Among patients with a left ventricular ejection fraction (LVEF) of ≤35%, annual SCD event rates were 4.0%, 0.9%, and 4.6% among groups with MTWA positive, negative, and indeterminate test results. The SCD rate was significantly lower among patients with a negative MTWA test result than in patients with either positive or indeterminate MTWA test results (P 35%, annual SCD event rates were 3.0%, 0.3%, and 0.3% among the groups with MTWA positive, negative, and indeterminate test results. The SCD rate associated with a positive MTWA test result was significantly higher than that associated with either negative (P 35%, a positive MTWA test result identifies patients at significantly heightened SCD risk. These findings may have important implications for refining primary prevention ICD treatment algorithms.

Original languageEnglish
JournalHeart Rhythm
Volume9
Issue number8
DOIs
Publication statusPublished - Aug 2012

    Fingerprint

Keywords

  • Arrhythmia
  • heart failure
  • ICD
  • Risk stratification
  • Sudden cardiac death
  • T-wave alternans

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Merchant, F. M., Ikeda, T., Pedretti, R. F. E., Salerno-Uriarte, J. A., Chow, T., Chan, P. S., Bartone, C., Hohnloser, S. H., Cohen, R. J., & Armoundas, A. A. (2012). Clinical utility of microvolt T-wave alternans testing in identifying patients at high or low risk of sudden cardiac death. Heart Rhythm, 9(8). https://doi.org/10.1016/j.hrthm.2012.03.014