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(Circulation. 2008;118:2013-2014.)
© 2008 American Heart Association, Inc.

Clinical Summaries

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Role of Microvolt T-Wave Alternans in Assessment of Arrhythmia Vulnerability Among Patients With Heart Failure and Systolic Dysfunction: Primary Results From the T-Wave Alternans Sudden Cardiac Death in Heart Failure Trial Substudy

 
Sudden cardiac death remains a leading cause of mortality despite advances in medical treatment for the prevention of ischemic heart disease and heart failure. Studies of the implantable cardioverter defibrillator (ICD) showed significant reductions in mortality among certain high-risk cohorts of patients. Recently, there has been a dramatic increase in ICD use for primary prevention, largely because of the results of 2 studies: the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) and the second Multicenter Automatic Defibrillator Implantation Trial (MADIT II). However, both studies showed that shocks for ventricular tachyarrhythmias occurred in only 25% to 35% of subjects during 4 to 5 years of follow-up. This suggests that many ICD patients may not benefit from this invasive therapy and that better risk stratification is needed to optimize patient selection. In this regard, microvolt T-wave alternans (TWA) is a noninvasive test of arrhythmia vulnerability. Previous observational studies showed that TWA predicted ICD shocks or arrhythmic events in diverse patient populations. This has led some to propose using TWA to identify patients most likely to benefit from ICD implantation; however, the value of TWA for risk stratification had not been evaluated previously in a randomized trial of ICD therapy. In the present study, 490 patients enrolled in SCD-HeFT underwent TWA testing and were followed up prospectively. TWA testing did not predict arrhythmic events or mortality in the cohort as a whole or in subgroups with ischemic or nonischemic cardiomyopathy. Accordingly, these results suggest that TWA is not useful as an aid . . . [Full Text of this Article]

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