Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?

Chow, Theodore; Kereiakes, Dean J.; Onufer, John; Woelfel, Alan; Gursoy, Sinan; Peterson, Brett J.; Brown, Mark L.; Pu, Wenji; Benditt, David G.

doi:10.1016/j.jacc.2008.08.018

Cited by 201Cardiac pacing and defibrillation studiesCardiac electrophysiology and arrhythmiasCardiac Arrhythmias and Treatments

Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?

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Chow, Theodore, Kereiakes, Dean J., Onufer, John, Woelfel, Alan, Gursoy, Sinan, Peterson, Brett J., Brown, Mark L., Pu, Wenji +1 more·2008·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2008.08.018

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Abstract

Objectives The purpose of this trial was to determine whether microvolt T-wave alternans (MTWA) predicts ventricular tachyarrhythmic events (VTEs) in post-myocardial infarction patients with left ventricular ejection fraction (LVEF) < or =30%.Background Previous studies have established MTWA as a predictor for total and arrhythmic mortality, but its ability to identify prophylactic implantable cardioverter-defibrillator (ICD) recipients most likely to experience VTEs remains uncertain.Methods This prospective trial was conducted at 50 U.S. centers. Patients were eligible if they met MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) indications for device implant. All patients underwent MTWA testing followed by ICD implantation, with pre-specified programming to minimize the likelihood of therapies for non-life-threatening VTE. Minimum follow-up was 2 years with annual MTWA testing. Initially indeterminate MTWA tests were repeated.Results Analyses were conducted on 575 patients (84% male; average age +/- SD = 65 +/- 11 years; average LVEF +/- SD = 0.24 +/- 0.05). The final distribution of MTWA results were: MTWA positive in 293 (51%), MTWA negative in 214 (37%), and indeterminate in 68 patients (12%). Over an average follow-up of 2.1 +/- 0.9 years, there were 70 VTEs. A VTE occurred in 48 of 361 (13%, 6.3%/year) MTWA non-negative and 22 of 214 (10%, 5.0%/year) MTWA negative patients. A non-negative MTWA test result was not associated with VTE (hazard ratio: 1.26; 95% confidence interval: 0.76 to 2.09; p = 0.37), although total mortality was significantly increased (hazard ratio: 2.04; 95% confidence interval: 1.10 to 3.78; p = 0.02).Conclusions In MADIT-II-indicated ICD-treated patients, the risk of VTE does not differ according to MTWA classification, despite differences in total mortality. (MASTER I-Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients; NCT00305240).

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Microvolt T-wave alternans classification did not predict the risk of ventricular tachyarrhythmic events in ICD-treated patients, although total mortality was significantly increased if MTWA was positive.
“Microvolt T-wave alternans (MTWA) classification did not predict the risk of ventricular tachyarrhythmic events in ICD treated patients, although total mortality was significantly increased if MTWA was positive.20”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [20]

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Authors: Chow, T., Kereiakes, D. J., Onufer, J., Woelfel, A., Gursoy, S., Peterson, B. J., Brown, M. L., Pu, W., & Benditt, D. G.
Affiliations: Christ Hospital (US)
Medtronic (United States) (US)
University of Minnesota (US)
ORCID: Kereiakes, Dean J.
Pu, Wenji
Benditt, David G.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2008-11
Volume: 52
Issue: 20
Pages: 1607-1615
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2008.08.018
OpenAlex: W84927980
Cited by: 201
References: 30
Citations by year: 2024: 3 · 2023: 4 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 3 · 2018: 11 · 2017: 12 · 2016: 10 · 2015: 12 · 2014: 11 · 2013: 21 · 2012: 23
FWCI: 18.68
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1718 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
Funders: Medtronic
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
Keywords: microvolt T-wave alternans, ventricular tachyarrhythmia, ischemic cardiomyopathy, implantable cardioverter-defibrillator, MADIT II, myocardial infarction, left ventricular ejection fraction, arrhythmia risk prediction, all-cause mortality
MeSH terms: Aged, Female, Heart Function Tests, Humans, Male, Middle Aged, Cardiomyopathies, Prospective Studies, Defibrillators, Implantable, Tachycardia, Ventricular, Myocardial Ischemia

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Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?

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