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T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art

  • Invasive Electrophysiology and Pacing (J Singh, Section Editor)
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Abstract

Microvolt level T-wave alternans (MTWA), a phenomenon of beat-to-beat variability in the repolarization phase of the ventricles, has been closely associated with an increased risk of ventricular tachyarrhythmic events (VTE) and sudden cardiac death (SCD) during medium- and long-term follow-up. Recent observations also suggest that heightened MTWA magnitude may be closely associated with short-term risk of impending VTE. At the subcellular and cellular level, perturbations in calcium transport processes likely play a primary role in the genesis of alternans, which then secondarily lead to alternans of action potential morphology and duration (APD). As such, MTWA may play a role not only in risk stratification but also more fundamentally in the pathogenesis of VTE. In this paper, we outline recent advances in understanding the pathogenesis of MTWA and also the utility of T-wave alternans testing for clinical risk stratification. We also highlight emerging clinical applications for MTWA.

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Acknowledgments

The work was supported by NIA grant 1R21AG035128, by a Fellowship and a Science Award from the Center for Integration of Medicine and Innovative Technology (CIMIT), a Post-doctoral Fellowship (#12POST9310001) from the American Heart Association and the Deane Institute for Integrative Research in Atrial Fibrillation and Stroke and the Cardiovascular Research Society.

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Faisal M. Merchant, Omid Sayadi, Kasra Moazzami, Dheeraj Puppala, and Antonis A. Armoundas declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Cardiology Division, Emory University School of Medicine, Atlanta, GA, USA

    Faisal M. Merchant

  2. Cardiovascular Research Center, Massachusetts General Hospital, 149 13th St, Charlestown, MA, 02129, USA

    Omid Sayadi, Kasra Moazzami, Dheeraj Puppala & Antonis A. Armoundas

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Merchant, F.M., Sayadi, O., Moazzami, K. et al. T-Wave Alternans as an Arrhythmic Risk Stratifier: State of the Art. Curr Cardiol Rep 15, 398 (2013). https://doi.org/10.1007/s11886-013-0398-7

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