Heart Rhythm
Volume 6, Issue 3, Supplement , Pages S29-S35 , March 2009

T-wave alternans in risk stratification of patients with nonischemic dilated cardiomyopathy: Can it help to better select candidates for ICD implantation?

  • Gaetano M. De Ferrari, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests and correspondence: Dr. Gaetano M. De Ferrari, Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, V.le Golgi 19, 27100, Pavia, Italy
    • ,
  • Antonio Sanzo, MD

References 

  1. Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death-executive summary: 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). Circulation. 2006;114:1088–1132
  2. Bardy GH, Lee KL, Mark DB, et al. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators Amiodarone or an implantable cardioverter–defibrillator for congestive heart failure. N Engl J Med. 2005;352:225–237
  3. Kadish A, Dyer A, Daubert JP, et al. Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE) Investigators Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 2004;350:2151–2158
  4. Rosenqvist M, Beyer T, Block M, et al. Adverse events with transvenous implantable cardioverter-defibrillators: a prospective multicenter study (European 7219 Jewel ICD investigators). Circulation. 1998;98:663–670
  5. Schron EB, Exner DV, Yao Q, et al. Quality of life in the antiarrhythmics versus implantable defibrillators trial: impact of therapy and influence of adverse symptoms and defibrillator shocks. Circulation. 2002;105:589–594
  6. Vermeulen JT. Mechanisms of arrhythmias in heart failure. J Cardiovasc Electrophysiol. 1998;9:208–221
  7. Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98:2334–2351
  8. De Ferrari GM, Tavazzi L. The role of arrhythmias in the progression of heart failure. Eur J Heart Fail. 1999;1:35–40
  9. Moss AJ, Zareba W, Hall WJ, et al. Multicenter automatic defibrillator implantation trial II investigators Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877–883
  10. Gomes JA, Winters SL, Ip J. Post myocardial infarction stratification and the signal-averaged electrocardiogram. Prog Cardiovasc Dis. 1993;35:263–270
  11. Buxton AE, Lee KL, DiCarlo L, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death (Multicenter Unsustained Tachycardia Trial Investigators). N Engl J Med. 2000;34:1937–1945
  12. De Ferrari GM, Rordorf R, Frattini F, et al. Predictive value of programmed ventricular stimulation in patients with ischaemic cardiomyopathy: implications for the selection of candidates for an implantable defibrillator. Europace. 2007;9:1151–1157
  13. Grimm W, Glaveris C, Hoffmann J, et al. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: design and first results of the Marburg Cardiomyopathy Study. Pacing Clin Electrophysiol. 1998;21:2551–2556
  14. Verrier RL, Tolat A. Dynamic repolarization changes and arrhythmia risk assessment in nonischemic heart disease. In:  Malik M,  Camm AJ editor. Dynamic Electrocardiography. Oxford, UK: Blackwell Futura; 2004;p. 454–462
  15. Qian YW, Clusin WT, Lin SF, et al. Spatial heterogeneity of calcium transient alternans during the early phase of myocardial ischeamia in the blood-perfused rabbit heart. Circulation. 2001;104:2082–2087
  16. Schwartz PJ, Malliani A. Electrical alternation of the T-wave: clinical and experimental evidence of its relationship with the sympathetic nervous system and with the long Q-T syndrome. Am Heart J. 1975;89:45–50
  17. Kovach JA, Nearing BD, Verrier RL. Angerlike behavioural state potentiates myocardial ischaemia-induced T-wave alternans in canines. J Am Coll Cardiol. 2001;37:1719–1725
  18. Klingenheben T, Zabel M, D'Agostino RB, et al. Predictive value of T-wave alternans for arrhythmic events in patients with congestive heart failure. Lancet. 2000;356:651–652
  19. Hennersdorf MG, Perings C, Niebch V, et al. T wave alternans as a risk predictor in patients with cardiomyopathy and mild-to-moderate heart failure. PACE. 2000;23:1386–1391
  20. Sakabe K, Ikeda T, Sakata T, et al. Comparison of T-wave alternans and QT interval dispersion to predict ventricular tachyarrhythmia in patients with dilated cardiomyopathy and without antiarrhythmic drugs: a prospective study. Jpn Heart J. 2001;42:451–457
  21. Adachi K, Ohnishi Y, Yokoyama M. Risk stratification for sudden cardiac death in dilated cardiomyopathy using microvolt-level T-wave alternans. Jpn Circ J. 2001;65:76–80
  22. Kitamura H, Ohnishi Y, Okajima K, et al. Onset heart rate of microvolt-level T-wave alternans provides clinical and prognostic value in nonischemic dilated cardiomyopathy. J Am Coll Cardiol. 2002;39:295–300
  23. Hohnloser SH, Klingenheben T, Bloomfield D, et al. Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study. J Am Coll Cardiol. 2003;41:2220–2224
  24. Grimm W, Christ M, Bach J, et al. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy (Results of the Marburg Cardiomyopathy Study). Circulation. 2003;108:2883–2891
  25. Bloomfield DM, Bigger JT, Steinman RC, et al. Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol. 2006;47:456–463
  26. Baravelli M, Fantoni C, Rogiani S, et al. Combined prognostic value of peak O2 uptake and microvolt level T-wave alternans in patients with idiopathic dilated cardiomyopathy. Int J Cardiol. 2007;131:23–29
  27. Gold RM, Ensley D, Chilson D, et al. T-Wave Alternans SCD HeFT study: primary endpoint analysis. Circulation. 2006;114(Suppl):II_428–II_429(abstr)
  28. Cantillon DJ, Stein KM, Markowitz SM, et al. Predictive value of microvolt T-wave alternans in patients with left ventricular dysfunction. J Am Coll Cardiol. 2007;50:166–173
  29. Salerno-Uriarte JA, De Ferrari GM, Klersy C, et al. ALPHA Study Group Investigators Prognostic value of T-wave alternans in patients with heart failure due to nonischemic cardiomyopathy. J Am Coll Cardiol. 2007;50:1896–1904
  30. Klingenheben T, Ptaszynski P, Hohnloser SH. Quantitative assessment of microvolt T-wave alternans in patients with congestive heart failure. J Cardiovasc Electrophysiol. 2005;16:620–624
  31. Verrier RL, Kwaku KF, Nearing BD, et al. T-wave alternans: does size matter?. J Cardiovasc Electrophysiol. 2005;16:625–627
  32. Minkkinen M, Kahonen M, Viik J, et al. Enhanced predictive power of quantitative TWA during routine exercise testing in the Finnish Cardiovascular Study. J Cardiovasc Electrophysiol. 2008;In press doi:10.1111/j.1540-8167.2008.01325.x

 There is no conflict of interest for Dr. Ferrari and Dr. Sanzo.

PII: S1547-5271(08)00975-2

doi: 10.1016/j.hrthm.2008.10.008

Heart Rhythm
Volume 6, Issue 3, Supplement , Pages S29-S35 , March 2009

Article Tools

* Image Usage & Resolution