Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators

Marco Paulo Tomaz Barbosa, Manoel Otávio da Costa Rocha, Elson Santos Neto, Fernando Vieira Brandão, Federico Lombardi, Antonio Luiz Pinho Ribeiro

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. Objective To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. Methods This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. Results Seventy-two patients were followed for a median time of 422 (range 294–642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8%) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3%); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results (p = 0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR = 2.7, 95% CI: 1.7–4.4, p = 0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100% in ChD patients. Conclusions MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.

Original languageEnglish
Pages (from-to)80-85
Number of pages6
JournalInternational Journal of Cardiology
Volume222
DOIs
Publication statusPublished - Nov 1 2016

Fingerprint

Chagas Disease
Implantable Defibrillators
Cardiac Arrhythmias
Therapeutics
Catheter Ablation
Anti-Arrhythmia Agents
Secondary Prevention
Tertiary Care Centers
Disease-Free Survival
Heart Diseases
Prospective Studies

Keywords

  • Chagas disease
  • Implantable cardioverter defibrillator
  • Microvolt T-wave alternans
  • Risk stratification
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators. / Barbosa, Marco Paulo Tomaz; da Costa Rocha, Manoel Otávio; Neto, Elson Santos; Brandão, Fernando Vieira; Lombardi, Federico; Ribeiro, Antonio Luiz Pinho.

In: International Journal of Cardiology, Vol. 222, 01.11.2016, p. 80-85.

Research output: Contribution to journalArticle

Barbosa, Marco Paulo Tomaz ; da Costa Rocha, Manoel Otávio ; Neto, Elson Santos ; Brandão, Fernando Vieira ; Lombardi, Federico ; Ribeiro, Antonio Luiz Pinho. / Usefulness of microvolt T-wave alternans for predicting outcome in patients with Chagas disease with implantable cardioverter defibrillators. In: International Journal of Cardiology. 2016 ; Vol. 222. pp. 80-85.
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abstract = "Background Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. Objective To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. Methods This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. Results Seventy-two patients were followed for a median time of 422 (range 294–642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8{\%}) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3{\%}); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results (p = 0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR = 2.7, 95{\%} CI: 1.7–4.4, p = 0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100{\%} in ChD patients. Conclusions MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.",
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AU - Barbosa, Marco Paulo Tomaz

AU - da Costa Rocha, Manoel Otávio

AU - Neto, Elson Santos

AU - Brandão, Fernando Vieira

AU - Lombardi, Federico

AU - Ribeiro, Antonio Luiz Pinho

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N2 - Background Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. Objective To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. Methods This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. Results Seventy-two patients were followed for a median time of 422 (range 294–642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8%) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3%); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results (p = 0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR = 2.7, 95% CI: 1.7–4.4, p = 0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100% in ChD patients. Conclusions MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.

AB - Background Chagas disease (ChD) may lead to life-threatening heart disease, including malignant ventricular arrhythmias. The use of implantable cardioverter defibrillators (ICDs) has become the main therapeutic strategy for secondary prevention of SCD in Chagas disease (ChD). Microvolt T-wave alternans (MTWA) is a direct measure of ventricular repolarization instability and has emerged as a potentially useful way of determining arrhythmia vulnerability. However, this methodology has not been evaluated in patients with ChD. Objective To evaluate the predictive value of MTWA testing for appropriate therapy or death in ChD patients with ICDs. Methods This prospective study included consecutive patients who received ICD implantations in a Brazilian tertiary referral center. Results Seventy-two patients were followed for a median time of 422 (range 294–642) days. Thirty-three patients had ChD. The MTWA was non-negative (positive or indeterminate) in 27 (81.8%) of ChD patients. The combined primary outcome (appropriate ICD therapy or death) occurred in 29 patients (40.3%); 17 out 33 ChD patients presented the primary outcome. There was a statistically significant difference in event-free survival between ChD patients with negative and non-negative MTWA results (p = 0.02). Non-negative MTWA tests nearly triple the risk of appropriate ICD therapy or death (HR = 2.7, 95% CI: 1.7–4.4, p = 0.01) in patients with ChD and was the only variable associated with outcomes. The sensitivity and the negative predictive value was 100% in ChD patients. Conclusions MTWA may be useful in recognizing high-risk ICD patients who may require adjunctive therapies with antiarrhythmic drugs or catheter ablation.

KW - Chagas disease

KW - Implantable cardioverter defibrillator

KW - Microvolt T-wave alternans

KW - Risk stratification

KW - Ventricular arrhythmia

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