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Curr Opin Cardiol. 2007 Jan;22(1):25-32.

Utility of microvolt T-wave alternans to predict sudden cardiac death in patients with cardiomyopathy.

Author information

1
Division of Cardiology, University Health Network, Toronto, Canada. vijay.chauhan@uhn.on.ca

Abstract

PURPOSE OF REVIEW:

Sudden cardiac death remains a major cause of mortality among patients with cardiomyopathy and implantable cardioverter-defibrillator therapy has been shown to improve survival in these patients. Effective use of prophylactic implantable cardioverter-defibrillator therapy requires accurate risk stratification beyond assessment of ejection fraction, however. Repolarization alternans is a harbinger of ventricular arrhythmias and its measurement from body-surface recordings, also known as microvolt T-wave alternans, is emerging as an effective prognostic tool in these patients based on recent clinical trials.

RECENT FINDINGS:

We review the pathogenesis and determinants of repolarization alternans. The current techniques for measuring T-wave alternans from the body surface are compared, including the spectral and modified moving average methods. Recent clinical trials evaluating the prognostic utility of T-wave alternans in patients with ischemic and nonischemic cardiomyopathy and no prior arrhythmic events are summarized. The findings of these studies are discussed in the context of implantable cardioverter-defibrillator prophylaxis. Body-surface T-wave alternans is an evolving technique and its limitations are presented along with approaches to improve its predictive accuracy.

SUMMARY:

Risk stratification with T-wave alternans has the potential to guide prophylactic implantable cardioverter-defibrillator therapy in a growing population of patients with cardiomyopathy.

PMID:
17143041
DOI:
10.1097/HCO.0b013e328011aa49
[Indexed for MEDLINE]

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