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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        • Hohnloser S.H.
        T-wave alternans.
        in: Zipes D.P. Jalife J. Cardiac Electrophysiology From Cell to Bedside. Fourth edition. WB Saunders, Philadelphia2004: 839-847
        • Verrier R.L.
        • Kwaku K.F.
        • Nearing B.D.
        • Josephson M.E.
        T-wave alternans.
        J Cardiovasc Electrophysiol. 2005; 16: 625-628
        • Nearing B.
        • Huang H.A.
        • Verrier R.L.
        Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave.
        Science. 1991; 252: 437-440
        • Zareba W.
        • Moss A.J.
        • le Cessie S.
        • Hall W.J.
        T-wave alternans in idiopathic long QT syndrome.
        J Am Coll Cardiol. 1994; 23: 1541-1546
        • Smith J.M.
        • Clancy E.A.
        • Valeri C.R.
        • Ruskin J.N.
        • Cohen R.J.
        Electrical alternans and cardiac electrical instability.
        Circulation. 1988; 77: 110-121
        • Hohnloser S.H.
        • Klingenheben T.
        • Zabel M.
        • Li Y.G.
        • Albrecht P.
        • Cohen R.J.
        T wave alternans during exercise and atrial pacing in humans.
        J Cardiovasc Electrophysiol. 1997; 8: 987-993
        • Bloomfield D.M.
        • Hohnloser S.H.
        • Cohen R.J.
        Interpretation and classification of microvolt T wave alternans tests.
        J Cardiovasc Electrophysiol. 2002; 13: 502-512
        • Bloomfield D.M.
        • Steinman R.C.
        • Namerow P.B.
        • Parides M.
        • Davidenko J.
        • Kaufman E.S.
        • Shinn T.
        • Curtis A.
        • Fontaine J.
        • Holmes D.
        • Russo A.
        • Tang C.
        • Bigger J.T.
        Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy.
        Circulation. 2004; 110: 1885-1889