This Article Full Text Full Text (PDF) All Versions of this Article: 109/15/1854    most recent 01.CIR.0000124717.77777.ECv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tanno, K. Articles by Katagiri, T. Search for Related Content PubMed PubMed Citation Articles by Tanno, K. Articles by Katagiri, T. Related Collections Primary prevention Electrocardiology Arrhythmias, clinical electrophysiology, drugs

(Circulation. 2004;109:1854-1858.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Microvolt T-Wave Alternans as a Predictor of Ventricular Tachyarrhythmias

A Prospective Study Using Atrial Pacing

Kaoru Tanno, MD; Syunsho Ryu, MD; Norikazu Watanabe, MD; Yoshino Minoura, MD; Mitsuharu Kawamura, MD; Taku Asano, MD; Youichi Kobayashi, MD; Takashi Katagiri, MD

From the Third Department of Internal Medicine, Showa University, Tokyo, Japan.

Correspondence to Kaoru Tanno, MD, Third Department of Internal Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. E-mail k-tanno{at}p02.itscom.ne

Received October 5, 2003; revision received January 9, 2004; accepted January 14, 2004.

Background— Microvolt T-wave alternans (TWA) is reported to be closely associated with sudden cardiac death (SCD) and ventricular tachycardia (VT). Animal experiments revealed that microvolt TWA is highly dependent on heart rate. The purpose of this study was to determine whether patients with TWA at relatively low heart rates have increased vulnerability to ventricular tachyarrhythmias.

Methods and Results— Subjects were 248 consecutive patients (158 men, 90 women; mean age, 59±17 years) who underwent electrophysiological study from 1997 to 2000. TWA recording was made in sinus rhythm and at atrial pacing rates of 90, 100, 110, and 120 bpm with the Cambridge Heart CH2000 system. Alternans voltage (V_alt) was measured when the alternans ratio was >3 for a period of >1 minute in VM, X, Y, Z, or 2 adjacent precordial leads. Study end point was the first appearance of VT, ventricular fibrillation (VF), appropriate implantable cardioverter-defibrillator therapy with pacing or shocks, or SCD. During the 37±12-month follow-up period, 22 patients had sustained VT, and 5 patients died of SCD. In patients with >1.9-µV V_alt at rates of 90, 100, and 110 bpm, the incidence of VT/VF/SCD was 56%, 28%, and 18%, respectively. V_alt of >2.9 µV at a heart rate of 90 bpm had a 70% positive predictive value for VT/VF/SCD. However, when V_alt was <0.9 µV at a rate of 120 bpm, negative predictive value was 100%.

Conclusions— Patients with TWA at relatively low heart rates are susceptible to ventricular tachyarrhythmias.

Key Words: death, sudden • heart rate • T-wave alternans • tachycardia, ventricular • fibrillation, ventricular

This article has been cited by other articles:

				J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention Circulation, September 30, 2008; 118(14): 1497 - 1518. [Full Text] [PDF]

				S. M. Narayan, M. R. Franz, G. Lalani, J. Kim, and A. Sastry T-Wave Alternans, Restitution of Human Action Potential Duration, and Outcome J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2385 - 2392. [Abstract] [Full Text] [PDF]

				D. J. Cantillon, K. M. Stein, S. M. Markowitz, S. Mittal, B. K. Shah, D. P. Morin, E. S. Zacks, M. Janik, S. Ageno, A. C. Mauer, et al. Predictive Value of Microvolt T-Wave Alternans in Patients With Left Ventricular Dysfunction J. Am. Coll. Cardiol., July 10, 2007; 50(2): 166 - 173. [Abstract] [Full Text] [PDF]

				S. M. Narayan, D. D. Drinan, R. P. Lackey, and C. F. Edman Acute volume overload elevates T-wave alternans magnitude J Appl Physiol, April 1, 2007; 102(4): 1462 - 1468. [Abstract] [Full Text] [PDF]

				T. Krogh-Madsen and D. J. Christini Action Potential Duration Dispersion and Alternans in Simulated Heterogeneous Cardiac Tissue with a Structural Barrier Biophys. J., February 15, 2007; 92(4): 1138 - 1149. [Abstract] [Full Text] [PDF]

				S. M. Narayan T-Wave Alternans and the Susceptibility to Ventricular Arrhythmias J. Am. Coll. Cardiol., January 17, 2006; 47(2): 269 - 281. [Abstract] [Full Text] [PDF]

				M. L. Koller, S. K.G. Maier, A. R. Gelzer, W. R. Bauer, M. Meesmann, and R. F. Gilmour Jr Altered Dynamics of Action Potential Restitution and Alternans in Humans With Structural Heart Disease Circulation, September 13, 2005; 112(11): 1542 - 1548. [Abstract] [Full Text] [PDF]

				A. K. Gehi, R. H. Stein, L. D. Metz, and J. A. Gomes Microvolt T-Wave Alternans for the Risk Stratification of Ventricular Tachyarrhythmic Events: A Meta-Analysis J. Am. Coll. Cardiol., July 5, 2005; 46(1): 75 - 82. [Abstract] [Full Text] [PDF]