T Wave Alternans And Ventricular Tachyarrhythmia Risk Stratification: A Review

Takagi, Masahiko and Yoshikawa, Junichi (2003) T Wave Alternans And Ventricular Tachyarrhythmia Risk Stratification: A Review. [Journal (Paginated)]

Full text available as:

[img] HTML


Sudden cardiac death (SCD) is one of the leading causes of mortality in industrialized countries. Thus, identifying patients at high risk of SCD is an important goal. T wave alternans (TWA) is a new method for identifying patients with lethal ventricular tachyarrhythmias, and is dependent on heart rate. The maximal predictive accuracy is achieved at heart rates between 100 and 120 bpm, so that TWA is usually measured during exercise, phamacological stress, or atrial pacing. It has been shown that TWA has high sensitivity and negative predictive value for predicting SCD after myocardial infarction and is also useful for predicting SCD in patients with nonischemic cardiomyopathy. Although the implantable cardioverter defibrillator (ICD) is now the primary therapy for preventing SCD, it is difficult to identify those patients who are susceptible to lethal ventricular tachyarrhythmias for primary prevention. In the prediction of SCD, TWA can be used as a screening test of appropriate patients for further electrophysiological examination and therapy.

Item Type:Journal (Paginated)
Keywords:T wave alternans, sudden cardiac death, ventricular tachyarrhythmia
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4286
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. AHA. American Heart Association: Heart and Stroke Statistical Update. Dallas, TX: 2001.

2. Moss AJ, Hall WJ, Cannom DS, et al.: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation trial investigators. N Engl J Med 1996;335:1933-40.

3. Prystowsky EN. Screening and therapy for patients with nonsustained ventricular tachycardia. Am J Cardiol 2000;86:K34-9.

4. Buxton AE, Lee KL, Fisher JD, et al.: A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 1999;341:1882-90.

5. Woo MA. Use of heart rate variability in specific popolations. In:Dunbar SB, Ellenbogen KA, Epstein AE, editors. Sudden Cardiac Death: Past, Present, and Future. Armonk, NY: Futura Publishing, 1997:163-85.

6. Farrell TG, Bashir Y, Cripps T, et al.: Risk stratification for arrhythmic events in postinfarction patients based on heart rate variability, ambulatory electrocardiographic variables and the signal-averaged electrocardiogram. J Am Coll Cardiol 1991;18:687-97.

7. Armoundas AA, Cohen RJ. Clinical utility of T-wave alternans. Card Electrophysiol Rev 1997;1:390-4.

8. Rosenbaum DS, Albrecht P, Cohen RJ. Prediction sudden cardiac death from T-wave alternans of the surface electrocardiogram: promise and pitfalls. J Cardiovasc Electrophysiol 1996;7:1095-111.

9. Habbab MA, El-Sherif N. TU alternans, long QTU, and torsade de pointes: Clinical and experimental observations. PACE 1992;15:916-31.

10. Hering HE. Das Wesen des Herzalternans. Munchen Med Wochenshr 1908;4:1417-21.

11. Kalter HH, Schwartz ML. Electrical alternans. N Y State J Med 1948;1:1164-6.

12. Nearing BD, Huang AH, Verrier RL. Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science 1991;252:437-40.

13. Konta T, Ikeda K, Yamaki M, et al: Significance of discordant ST alternans in ventricular fibrillation. Circulation 1990;82:2175-9.

14. Puletti M, Curione M, Righetti G, et al.: Alternans of the ST segment and T wave in acute myocardial infarction. J Electrocardiol 1980;13:297-300.

15. Kleinfeld MJ, Rozanski JJ. Alternans of the ST segment in Prinzmetal's angina. Circulation 1977;55:574-7.

16. Cheng TC. Electrical alternans. An association with coronary artery spasm. Arch Intern Med 1983;143:1052-3.

17. Reddy CV, Kiok JP, Khan RG, et al.: Repolarization alternans associated with alcoholism and hypomagnesemia. Am J Cardiol 1984;53:390-1.

18. Shimoni Z, Flatau E, Schiller D, et al: Electrical alternans of giant U waves with multiple electrolyte deficits. Am J Cardiol 1984;54:920-1.

19. Momiyama Y, Hartikainen J, Nagayoshi H, et al: Exercise-induced T-wave alternans as a marker of high risk in patients with hypertrophic cardiomyopathy. Jpn Circ J 1997;61:650-6.

20. Schwartz P, Malliani A. Electrical alternation of the T-wave: clinical and experimental evidence of its relationship with the sympathetic nervous system and with the long QT syndrome. Am Heart J 1975;89:45-50.

21. Zareba W, Moss AJ, Le Cessie S, et al: T wave alternans in idiopathic long QT syndrome. J Am Coll Cardiol 1994;23:1541-6.

22. Platt SB, Vijgen JM, Albrecht P, et al: Occult T-wave alternans in long QT syndrome. J Cardiovasc Electrophysiol 1996;7:144-8.

23. Takagi M, Doi A, Takeuchi K, et al: Pilsicanide-induced marked T wave alternans and ventricular fibrillation in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2002;13:837.

24. Chinushi M, Washizuka T, Okumura H, et al.: Intravenous administration of class Ic antiarrhythmic drugs induced T wave alternans in a patient with Brugada syndrome. J Cardiovasc Electrophysiol 2001;12:493-5.

25. Adam DR, Powell AO, Gordon H, et al: Ventricular fibrillation and fluctuations in the magnitude of the reporalization vector. IEEE Comput Cardiol 1982;241-4.

26. Adam DR, Smith JM, Akselrod S, et al: Fluctuations in T-wave morphology and susceptibility to ventricular fibrillation. J Electrocardiol 1984;17:209-18.

27. Smith JM, Clancy EA, Valeri CR, et al: Electrical alternans and cardiac electrical instability. Circulation 1988;77:110-21.

28. Choi BR, Salama G. Simultaneous maps of optical action potentials and calcium transients in guinea-pig hearts: mechanisms underlying concordant alternans. J Physiol 2000;529:171-88.

29. Cohn JN, Archibald DG, Ziesche S, et al: Effect of vasodilator therapy on mortality in chronic congestive heart failure. Results of a Veterans Administraction Cooperative Study. N Engl J Med 1986;314:1547-52.

30. Miyoshi S, Miyazaki T, Moritani K, et al: Different responses of epicardium and endocardium to KATP channel modulators during regional ischemia. Am J Physiol 1996;271:H140-7.

31. Kleber AG, Janse MJ, van Capelle FJ, et al: Mechanism and time course of ST and TQ segment changes during acute regional myocardial ischemia in the pig heart determined by extracellular and intracellular recordings. Circ Res 1978;42:603-13.

32. Dilly SG, Lab MJ. Electrophysiological alternans and restitution during acute regional ischemia in myocardium of anaesthetized pig. J Physiol 1988;402:315-33.

33. Kuo CS, Amlie JP, Munakata K, et al. Dispersion of monophasic action potential durations and activation times during atrial pacing, ventricular pacing, and ventricular premature stimulation in canine ventricles. Cardiovasc Res 1983;17:152-61.

34. Shimizu W, Anzelevitch C. Cellular and ionic basis for T-wave alternans under long QT conditions. Circulation 1999;99:1499-507.

35. Pastore JM, Girouard SD, Laurita KR, et al.: Mechanism linking T-wave alternans to the genesis of cardiac fibrillation. Circulation 1999;99:1385-94.

36. Cohen RJ: In Zipes DJ, Jalife J (eds.): Cardiac Electrophysiology: from cell to bedside. 3rd edition. Philadelphia, WB Saunders, 2000.

37. Bloomfield DM, Cohen RJ. Repolarization alternans. In: Malik M, editor. Risk of Arrhythmia and Sudden Death. London: BNJ Books, 2001,256-65.

38. Tanno K, Kobayashi Y, Adachi T, et al.: Onset heart rate on microvolt T wave alternans during atrial pacing. Am J Cardiol 2000;86:877-80.

39. Kavesh NG, Shorofsky SR, Sarang SE, et al.: Effect of heart rate on T wave alternans. J Cardiovasc Electrophysiol 1997;8:987-93.

40. Rosenbaum D, Jackson LE, Smith JM, et al.: Electrical alternans and vulnerability to ventricular arrhythmias. N Engl J Med 1994;330:235-41.

41. Gold MR, Bloomfield DM, Anderson KP, et al.: A comparison of T wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol 2000;36:2247-53.

42. Ikeda T, Sakata T, Takami M, et al.: Combined assessment of T wave alternans and late potentials used to predict arrhythmic events after myocardial infarction. A prospective study. J Am Coll Cardiol 2000;35:722-30.

43. Ikeda T, Saito H, Tanno K, et al.: T wave alternans as a predictor for sudden cardiac death after nyocardial infarction. Am J Cardiol 2002;89:79-82.

44. Adachi K, Ohnishi Y, Shima T, et al.: Determinant of microvolt-level T wave alternans in patients with dilated cardiomyopathy. J Am Coll Cardiol 1999;34:374-80.

45. 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;356:651-2.

46. 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.

47. Ikeda T, Sakurada H, Sakabe K, et al.: Assessment of noninvasive markers in identifying patients at risk in the Brugada syndrome: insight into risk stratification. J Am Coll Cardiol 2001;37:1628-34.


Repository Staff Only: item control page