Athletes, Ventricular Arrhythmias, Electrophysiological Testing, Microvolt T-Wave Alternans, and a Follow-Up of 30 21 Months: A Need for Follow-Up Updates

Background: Decades of research now link TWA with inducible and spontaneous clinical ventricular arrhythmias. This bench-to-bedside foundation makes TWA, NT-ProBNP a very plausible index of susceptibility to ventricular arrythmia, and motivates the need to define optimal combination of TWA and NT-ProBNP in predicting ventricular arrythmia in myocardial infarction patients. We research this study with 2 targets: 1. To evaluate the role of TWA in predicting sudden cardiac death in myocardial infarction patients. 2. To evaluate the role of NT-ProBNP in predicting sudden cardiac death in myocardial infarction patients 3. Evaluate the role of the combined NT-ProBNP and TWA in predicting sudden cardiac death in myocardial infarction patients. Methods: Prospective study with follow up the mortality in 2 years: 71 chronic myocardial infarction patients admitted to hospital from 5/2009 to 5/20011 and 50 healthy person was done treadmill test to caculate TWA; ECG, echocardiography, NT-ProBNP. Results: Cut-off point of NT-ProBNP in predicting sudden cardiac death is 3168 pg/ml; AUC = 0,86 (95% CI: 0,72 - 0,91); Cut-off point of TWA in predicting sudden cardiac death is 107 µV; AUC = 0,81 (95% CI: 0,69 - 0,87); NT-ProBNP can predict sudden cardiac death with OR= 7,26 (p<0,01); TWA can predict sudden cardiac death with OR= 8,45 (p<0,01). The combined NT-ProBNP and TWA in predicting ventricular arrythmia in heart failure patients: OR= 17,91 (p<0,001). Conclusions: The combined NT-ProBNP and TWA have the best predict value of sudden cardiac death in myocardial infarction patients, compare to NT-ProBNP or TWA alone

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T-Wave Alternans and Ventricular Arrhythmias in Athletes: Usefulness of Follow-up Updates

Annals of Noninvasive Electrocardiology ◽

10.1111/j.1542-474x.2008.00280.x ◽

2009 ◽

Vol 14 (1) ◽

pp. 99-99

Author(s):

Giuseppe Inama ◽

Claudio Pedrinazzi

Keyword(s):

Ventricular Arrhythmias ◽

T Wave ◽

T Wave Alternans

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T-Wave Alternans in Risk Stratification of Athletes with Ventricular Arrhythmias: Correlation with Electrophysiological Testing Results

EP Europace ◽

10.1016/j.eupc.2005.08.086 ◽

2005 ◽

Vol 7 ◽

pp. S30-S30

Author(s):

O DURIN ◽

G INAMA ◽

M NANETTI ◽

C PEDRINAZZI ◽

G DONATO ◽

...

Keyword(s):

Risk Stratification ◽

Ventricular Arrhythmias ◽

T Wave ◽

Electrophysiological Testing ◽

T Wave Alternans

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Microvolt QRS Alternans Without Microvolt T‐Wave Alternans in Human Cardiomyopathy: A Novel Risk Marker of Late Ventricular Arrhythmias

Journal of the American Heart Association ◽

10.1161/jaha.119.016461 ◽

2020 ◽

Vol 9 (17) ◽

Author(s):

Adrian Suszko ◽

Sachin Nayyar ◽

Christopher Labos ◽

Kumaraswamy Nanthakumar ◽

Arnold Pinter ◽

...

Keyword(s):

Ventricular Arrhythmias ◽

Event Rate ◽

Ventricular Tachyarrhythmia ◽

T Wave ◽

Qrs Prolongation ◽

Surface Ecg ◽

Qrs Duration ◽

T Wave Alternans ◽

Cox Analysis

Background Action potential alternans can induce ventricular tachyarrhythmias and manifest on the surface ECG as T‐wave alternans (TWA) and QRS alternans (QRSA). We sought to evaluate microvolt QRSA in cardiomyopathy patients in relation to TWA and ventricular tachyarrhythmia outcomes. Methods and Results Prospectively enrolled cardiomyopathy patients (n=100) with prophylactic defibrillators had 12‐lead ECGs recorded during ventricular pacing from 100 to 120 beats/min. QRSA and TWA were quantified in moving 128‐beat segments using the spectral method. Segments were categorized as QRSA positive (QRSA+) and/or TWA positive (TWA+) based on ≥2 precordial leads having alternans magnitude >0 and signal:noise >3. Patients were similarly categorized based on having ≥3 consecutive segments with alternans. TWA+ and QRSA+ occurred together in 31% of patients and alone in 18% and 14% of patients, respectively. Although TWA magnitude (1.4±0.4 versus 4.7±1.0 µV, P <0.01) and proportion of TWA+ studies (16% versus 46%, P <0.01) increased with rate, QRSA did not change. QRS duration was longer in QRSA+ than QRSA‐negative patients (138±23 versus 113±26 ms, P <0.01). At 3.5 years follow‐up, appropriate defibrillator therapy or sustained ventricular tachyarrhythmia was greater in QRSA+ than QRSA‐negative patients (30% versus 8%, P =0.02) but similar in TWA+ and TWA‐negative patients. Among QRSA+ patients, the event rate was greater in those without TWA (62% versus 21%, P =0.02). Multivariable Cox analysis revealed QRSA+ (hazard ratio [HR], 4.6; 95% CI, 1.5–14; P =0.009) and QRS duration >120 ms (HR, 4.1; 95% CI, 1.3–12; P =0.014) to predict events. Conclusions Microvolt QRSA is novel phenomenon in cardiomyopathy patients that can exist without TWA and is associated with QRS prolongation. QRSA increases the risk of ventricular tachyarrhythmia 4‐fold, which merits further study as a risk stratifier.

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