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Clinical significance of microvolt T-wave alternans

Bedeutung des Mikrovolt-T-Wellen-Alternans

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Zusammenfassung

Verschiedene Studien haben nachgewiesen, dass eine primärpräventive Therapie mit implantierbaren Defibrillatoren (ICD) bei selektierten Patienten die Prognose verbessert. Allerdings liegt die Anzahl der mit einem ICD zu behandelnden Patienten bei 11 bis 17 um 1 Leben zu retten. Insofern ist eine akkuratere Identifikation von Hochrisikopatienten essentiell, um möglicherweise unnötige ICD-Implantationen zu vermeiden. Der T-Wellen-Alternans im Mikrovoltbereich (mTWA) ist jüngst als Marker einer abnormen ventrikulären Repolarisation identifiziert worden. Die vorliegende Arbeit fasst den aktuellen Stand der Literatur zur klinischen Anwendbarkeit des mTWA zusammen.

Abstract

Several studies have recently proven that primary preventive therapy of sudden arrhythmogenic death is possible in selected patients with congestive heart failure, particularly in the setting of ischemic cardiomyopathy [1, 2]. However, a number needed to treat between 11 and 17 to save one life over three years in these studies indicates that a more accurate identification of high risk patients is desirable in order to avoid unnecessary implants of cardioverter/defibrillators (ICD). Since currently available risk stratification methods have limited predictive accuracy, development of new techniques is important in order to non-invasively assess arrhythmogenic risk in patients prone to sudden death. Microvolt level T-wave alternans (mTWA) has recently been proposed to assess abnormalities in ventricular repolarization favoring the occurrence of reentrant arrhythmias [3, 4]. In 1994, a first clinical study by Rosenbaum and coworkers [5] convincingly demonstrated that mTWA is closely related to arrhythmia induction in the electrophysiology (EP) laboratory as well as to the occurrence of spontaneous ventricular tachyarrhythmias during follow-up [5]. More recently, a number of clinical studies has examined its clinical applicability [4–7]. The present review summarizes currently available clinical data on TWA with a particular focus on risk stratifying patients with congestive heart failure and myocardial infarction.

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References

  1. Moss AJ, Zareba W, Hall WJ, et al. (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883

    Article  PubMed  Google Scholar 

  2. Bardy GH, Lee KL, Mark DB, et al. (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237

    Article  PubMed  CAS  Google Scholar 

  3. Adam DR, Smith JM, Akselrod S, Nyberg S, Powell AO, Cohen RJ (1984) Fluctuations in T wave morphology and susceptibility to ventricular fibrillation. J Electrocardiol 17:209–218

    Article  PubMed  CAS  Google Scholar 

  4. Pastore JM, Girouard SD, Laurita KR, Akar FG, Rosenbaum DS (1999) Mechanism linking T-wave alternans to the genesis of cardiac fibrillation. Circulation 99:1385–1394

    PubMed  CAS  Google Scholar 

  5. Rosenbaum DS, Jackson LE, Smith JM, Garan H, Ruskin JN, Cohen RJ (1994) Electrical alternans and vulnerability to ventricular arrhythmias. N Engl J Med 330:235–241

    Article  PubMed  CAS  Google Scholar 

  6. Schwartz PJ, Malliani A (1975) 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 89:45–50

    Article  PubMed  CAS  Google Scholar 

  7. Adam DR, Akselrod S, Cohen RJ (1981) Estimation of ventricular vulnerability to fibrillation through T wave time series analysis. Comput Cardiol 1981:307–310

    Google Scholar 

  8. Shimizu W, Antzelevitch C (1999) Cellular and ionic basis for T-wave alternans under long QT conditions. Cirulation 99:1499–1507

    CAS  Google Scholar 

  9. Koller ML, Maier SK, Gelzer AR, Bauer WR, Meesmann M, Gilmour RF Jr (2005) Altered dynamics of action potential restitution and alternans in humans with structural heart disease. Circulation 112:1542–1548

    Article  PubMed  Google Scholar 

  10. Selvaraj RJ, Picton P, Nanthakumar K, Mak S, Chauhan VS (2007) Endocardial and epicardial repolarization alternans in human cardiomyopathy: evidence for spatiotemporal heterogeneity and correlation with body surface T-wave alternans. J Am Coll Cardiol 49:338–346

    Article  PubMed  Google Scholar 

  11. Laurita KR, Singal A, Pastore JM, Rosenbaum DS (1998) Spatial heterogeneity of calcium transients may explain action potential dispersion during T-wave alternans (abstr) Circulation 98 (suppl):I-187

    Google Scholar 

  12. Rosenbaum DS, Albrecht P, Cohen RJ (1996) Predicting sudden cardiac death from T wave alternans of the surface electrocardiogram: promise and pitfalls. J Cardiovasc Electrophysiol 7:1095–1111

    PubMed  CAS  Google Scholar 

  13. Gold MR, Bloomfield DM, Anderson KP, El-Sherif NE, Wilber DJ, Groh WJ, Estes NAM, Kaufman ES, Greenberg ML, Rosenbaum DS (2000) A comparison of T-wave alternans, signal- averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol 36:2247–2253

    Article  PubMed  CAS  Google Scholar 

  14. Ikeda T, Sakata T, Takami M, Kondo N, Tezuka N, Nakae T, Noro M, Enjoji Y, Abe R, Sugi K, Yamaguchi T (2000) Combined assessment of Twave alternans and late potentials used to predict arrhythmic events after myocardial infarction. J Am Coll Cardiol 35:722–730

    Article  PubMed  CAS  Google Scholar 

  15. Tapanainen JM, Still AM, Airaksinen KEJ, Huikuri HV (2001) Prognostic significance of risk stratifiers of mortality, including T-wave alternans, after acute myocardial infarction: results of a prospective follow-up study. J Cardiovasc Electrophysiol 12:645–652

    Article  PubMed  CAS  Google Scholar 

  16. Ikeda T, Saito H, Tanno K, Shimizu H, Watanabe J, Ohnishi Y, Kasamaki Y, Ozawa Y (2002) T-wave alternans as a predictor for sudden cardiac death after myocardial infarction. Am J Cardiol 89:79–82

    Article  PubMed  Google Scholar 

  17. Ikeda T, Yoshino H, Sugi K, Tanno K, Shimizu H, Watanabe J, Kasamaki Y, Yoshida A, Kato T (2006) Predictive value of microvolt T-wave alternans for sudden cardiac death in patients with preserved cardiac function after acute myocardial infarction: results of a collaborative cohort study. J Am Coll Cardiol 48:2268–2274

    Article  PubMed  Google Scholar 

  18. Hohnloser SH, Ikeda T, Bloomfield DM, Dabbous OH, Cohen RJ (2003) T-wave alternans negative coronary patients with low ejection and benefit from defibrillator implantation. Lancet 362:125–126

    Article  PubMed  CAS  Google Scholar 

  19. Klingenheben T, Zabel M, D'Agostino RB, Cohen RJ, Hohnloser SH (2000) Predictive value of T-wave alternans for arrhythmic events in patients with congestive heart failure. Lancet 356:651–652

    Article  PubMed  CAS  Google Scholar 

  20. Bloomfield DM, Steinman RC, Namerow PB, Parides M, Davidenko J, Kaufman ES, Shinn T, Curtis A, Fontaine J, Holmes D, Russo A, Tang C, Bigger JT Jr (2004) Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: a solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. Circulation 110:1885–1889

    Article  PubMed  Google Scholar 

  21. Chow T, Kereiakes DJ, Bartone C, Booth T, Schloss EJ, Waller T, Chung ES, Menon S, Nallamothu BK, Chan PS (2006) Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy. J Am Coll Cardiol 47:1820–1827

    Article  PubMed  Google Scholar 

  22. Chan PS, Stein K, Chow T, Fendrick M, Bigger JT, Vijan S (2006) Cost-effectiveness of a microvolt T-wave alternans screening strategy for implantable cardioverter-defibrillator placement in the MADIT-II-eligible population. J Am Coll Cardiol 48:112–121

    Article  PubMed  Google Scholar 

  23. Chow T, Kereiakes DJ, Bartone C, Booth T, Schloss EJ, Waller T, Chung E, Menon S, Nallamothu BK, Chan PS (2007) Microvolt T-wave alternans identifies patients with ischemic cardiomyopathy who benefit from implantable cardioverter-defibrillator therapy. J Am Coll Cardiol 49:50–58

    Article  PubMed  Google Scholar 

  24. Bloomfield DM, Bigger JT, Steinman RC, Namerow PB, Parides MK, Curtis AB, Kaufman ES, Davidenko JM, Shinn TS, Fontaine JM (2006) Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction. J Am Coll Cardiol 47:456–463

    Article  PubMed  Google Scholar 

  25. Hohnloser SH, Klingenheben T, Bloomfield D, Dabbous O, Cohen RJ (2003) Usefulness of microvolt Twave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study. J Am Coll Cardiol 41:2220–2224

    Article  PubMed  Google Scholar 

  26. Grimm W, Christ M, Bach J, Muller HH, Maisch B (2003) Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: results of the Marburg Cardiomyopathy Study. Circulation 108:2883–2891

    Article  PubMed  Google Scholar 

  27. Study to Compare TWA Test and EPS Test for Predicting Patients at Risk for Life-Threatening Heart Rhythms (ABCD). http://clinicaltrials.gov/ct/gui/show/NCT00187291

  28. MASTER I – Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients. http://clinicaltrials. gov/ct/show/NCT00305240

  29. Russo AM, Marchlinski FE (2007) Should microvolt T-wave alternans be utilized routinely in selecting patients for prophylactic implantable cardioverter- defibrillator insertion in the setting of ischemic heart disease? J Am Coll Cardiol 49:59–61

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Praxis für Kardiologie, Alfred-Bucherer-Str. 6, 53115, Bonn, Germany

    T. Klingenheben

  2. J. W. Goethe University, Frankfurt, Germany

    T. Klingenheben

  3. Medical University Hospital, Lodz, Poland

    P. Ptaszynski

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  1. T. Klingenheben
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Correspondence to T. Klingenheben.

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Klingenheben, T., Ptaszynski, P. Clinical significance of microvolt T-wave alternans. Herzschr. Elektrophys. 18, 39–44 (2007). https://doi.org/10.1007/s00399-007-0553-1

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  • DOI: https://doi.org/10.1007/s00399-007-0553-1

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