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(Circulation. 2007;116:2984-2991.)
© 2007 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Is Microvolt T-Wave Alternans the Answer to Risk Stratification in Heart Failure?

Rachel C. Myles, MA, MRCP; Colette E. Jackson, BSc, MRCP; Ioannis Tsorlalis, MD; Mark C. Petrie, BSc, MRCP; John J. V. McMurray, MD, FRCP; Stuart M. Cobbe, MD, FRCP

From the British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow (R.C.M., C.E.J., I.T., J.J.V.M., S.M.C.) and the Department of Cardiology, Royal Infirmary (M.C.P.), Glasgow, United Kingdom.

Correspondence to Dr Stuart M. Cobbe, Department of Medical Cardiology, Royal Infirmary, Glasgow G31 2ER, UK. E-mail stuart.cobbe@clinmed.gla.ac.uk

Key Words: death, sudden • heart failure • implantable cardioverter-defibrillator • T-wave alternans

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

	Introduction

 
Despite recent advances in the prevention and treatment of cardiovascular disease, sudden cardiac death (SCD) still accounts for 50% of all cardiovascular deaths in developed countries, thus accounting for a significant proportion of annual death worldwide.¹ Reduction of the incidence of SCD depends on identification of those at most risk. In the present review we will concentrate on the challenges of risk stratification for SCD in chronic heart failure (CHF). We evaluate the utility of microvolt T-wave alternans (MTWA) as a tool for predicting SCD and consider whether MTWA is currently a valid means of selecting which patients should, or should not, receive an implantable cardioverter-defibrillator (ICD).

	Prevention of Sudden Cardiac Death

 
Until recently, attempts to prevent SCD relied on pharmacological therapy. β-Blockers,² angiotensin-converting enzyme inhibitors,³ angiotensin receptor blockers⁴ and aldosterone antagonists⁵ modestly reduce the risk of SCD in patients with CHF and after myocardial infarction (MI), whereas antiarrhythmic therapy has largely failed.⁶ Despite such treatments, these patients remained at high risk until the advent of the ICD. Although ICDs have further reduced the risk of SCD, they are expensive and can be associated with significant morbidity; therefore, precisely targeting their use is crucial. Implantation of ICDs for secondary prevention is clear. Prior sustained ventricular arrhythmia confers high risk and the benefit/risk balance is clearly favorable.⁷ Also, the secondary prevention population is relatively small and readily identified, thus the financial costs are not insurmountable.

Primary prevention ICD therapy is an entirely different scenario. Large, randomized controlled trials have shown a mortality benefit with ICDs in . . . [Full Text of this Article]

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