scholarly journals Microvolt T-wave Alternans: Where Are We Now?

2016 ◽  
Vol 5 (1) ◽  
pp. 37 ◽  
Author(s):  
Aapo L Aro ◽  
◽  
Tuomas V Kenttä ◽  
Heikki V Huikuri ◽  
◽  
...  
Keyword(s):  
Average Method ◽  
Ventricular Arrhythmias ◽  
Moving Average ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Sufficient Evidence ◽  
T Wave ◽  
T Wave Alternans ◽  
The Time Domain ◽  
Important Marker

Microvolt T-wave alternans (TWA), characterised as beat-to-beat fluctuation of T-wave amplitude and morphology, is an electrophysiological phenomenon associated clinically with impending ventricular arrhythmias and is an important marker of arrhythmia risk. Currently, two main methods for the detection of TWA exist, namely, the spectral method and the time-domain modified moving average method; both are discussed in this review. Microvolt TWA has been associated with cardiovascular mortality and sudden cardiac death in several clinical studies involving >14,000 subjects with reduced as well as preserved left ventricular function. Although TWA appears to be a useful marker of susceptibility for lethal ventricular arrhythmias and cardiovascular death, so far there is no sufficient evidence from randomised clinical trials to support its use in guiding therapy. However, several ongoing trials are expected to provide more information about the clinical use of TWA testing.

scholarly journals Microvolt T-Wave Alternans and the Risk of Death or Sustained Ventricular Arrhythmias in Patients With Left Ventricular Dysfunction

2006 ◽  
Vol 47 (2) ◽  
pp. 456-463 ◽  
Author(s):  
Daniel M. Bloomfield ◽  
J. Thomas Bigger ◽  
Richard C. Steinman ◽  
Pearila B. Namerow ◽  
Michael K. Parides ◽  
...  
Keyword(s):  
Left Ventricular Dysfunction ◽  
Ventricular Arrhythmias ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Risk Of Death ◽  
T Wave ◽  
T Wave Alternans

scholarly journals Clinical Implication of Early Repolarization

2013 ◽  
pp. 178-89
Author(s):  
Reza Octavianus ◽  
Yoga Yuniadi ◽  
Budhi Setianto
Keyword(s):  
Risk Stratification ◽  
Ventricular Arrhythmias ◽  
Moving Average ◽  
Cardiac Cells ◽  
Normal Variant ◽  
Qrs Complex ◽  
Early Repolarization ◽  
T Wave ◽  
St Segment ◽  
T Wave Alternans

Early repolarization described as J-point elevation with concaved ST segment, notch or slurred at terminal QRS complex on surface electrokardiography. This electrokardiography pattern that usually exists in young male population, for about 60 years has been concluded as benign normal variant electrokardiography. Klatsky in 2002, has strengthed this issues with his study with 1000 elecrokardiographies with early repolarization which were followed for 12 years. There was no significant case for hospitality or malignant ventricular arrhythmias among population with early repolarization comparared with normal elektrokardiography without early repolarization.But, recent studies with larger samples, show different thing, which is there was a correlation between early repolarization and malignat ventricular arrhythmias. So the issue is, whether we can still consider this early repolarization as a normal variant or not. And how about the management of asymptomatic population with early repolarization such as syncope or evidence of malignant ventricular arrhythmias.T-wave Alternans is a difference at amplitude or morphology of ST segment and T wave in every other heart beat. T-wave Alternans measurement is a non-invasive method to value cardiac cells hererogeneity. This examination has been proven to be useful as a risk stratification for malignant ventricular arrhythmias events in large studies. Higher T-wave Alternans value accompanied with higher risk for developing these arrythymias. T-wave Alternans measurement has been approved in the guideline for management of wide QRS complex tachyarrythmias for detection ventricular arrhythmias with I and IIa class of recommedantion. The more practical Modified Moving Average technicque which can be performed in healthy subjects with early repolarization is useful for risk stratification. Large studies have approved the use of Modified Moving Average for measure T-wave Alternans in these arrhythmias risk stratification.

RESEARCH THE VALUE OF THE COMBINATION OF T WAVE ALTERNANS AND NT-PROBNT IN PREDICTING SUDDEN CARDIAC DEATH

2012 ◽  
pp. 74-83
Author(s):  
Anh Tien Hoang ◽  
Nhat Quang Nguyen
Keyword(s):  
Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Healthy Person ◽  
Treadmill Test ◽  
T Wave ◽  
T Wave Alternans

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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