Abstract 4118: Crescendo T-Wave Alternans Prior to VT in Hospitalized Decompensated Heart Failure Patients in the PRECEDENT Trial
Hospitalized patients with acute decompensated heart failure are at high risk for life-threatening ventricular arrhythmias. We examined whether T-wave alternans (TWA) magnitude on ambulatory ECGs (AECGs) could provide warning of malignant ventricular tachycardia (VT). AECGs (leads V1, V5, and aVF) recorded before initiation of drug therapy from patients enrolled in the Prospective Randomized Evaluation of Cardiac Ectopy with Dobutamine or Nesiritide Therapy (PRECEDENT) trial were analyzed. TWA was measured by Modified Moving Average (MMA) analysis, which detects transitory changes. Stable recordings with ≥120 min sinus rhythm preceding the arrhythmia were identified in 22 patients. Starting at 30 min prior to VT, TWA was elevated above baseline at 60 –120 minutes before VT (p<0.05 for V1, V5, aVF, by ANOVA and Tukey Test for multiple comparisons). In V1, TWA increased from baseline (17.4±2.1 to 24.2±3.9 at 15–30 min prior to VT and to 29.2±3.8 μV at 0 –15 min prior to VT). In V5, TWA increased from baseline (18.6±2.1 to 27.9±4.6 at 15–30 min prior to VT and to 26.6±3.6 μV at 0 –15 min prior to VT). In aVF, TWA increased from baseline (18.3±1.9 to 25.5±3.9 at 15–30 min prior to VT and to 28.3±4.2 at 0 –15 min prior to VT). (Figure illustrates TWA in precordial lead V5 in seconds prior to the arrhythmia.) In hospitalized patients with decompensated heart failure, a crescendo in TWA magnitude heralds onset of life-threatening VT. These data suggest that telemetry monitoring for increases in TWA magnitude during the critical care phase may be useful in alerting staff to heightened arrhythmia risk.
This research has received full or partial funding support from the American Heart Association, AHA Founders Affiliate (Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont).