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How to analyze T-wave alternans

      Noninvasive detection of patients prone to ventricular tachyarrhythmias and sudden cardiac death using measurements of ventricular repolarization derived from the 12-lead surface ECG has received enormous interest. Among the methods introduced for this purpose are assessment of QT dispersion, determination of QT dynamics assessed from long-term ECG recordings, and morphologic assessment of T-wave patterns. Analysis of microvolt T-wave alternans has emerged as the most promising. Considerable experimental evidence links microvolt T-wave alternans to the genesis of life-threatening ventricular tachyarrhythmias.
      • Hohnloser S.H.
      T-wave alternans.
      Over the last decade, several hundred studies of microvolt T-wave alternans have been published.
      • Verrier R.L.
      • Kwaku K.F.
      • Nearing B.D.
      • Josephson M.E.
      T-wave alternans does size matter?.
      Evidence from these trials indicates that noninvasive assessment of microvolt T-wave alternans is an important tool for determining the risk for ventricular tachyarrhythmic events in patients with ischemic and nonischemic cardiomyopathy. This article reviews the practical aspects of how microvolt T-wave alternans is assessed and analyzed in clinical practice.
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