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- Title
Ambulatory Electrocardiogram-Based Tracking of T Wave Alternans in Postmyocardial Infarction Patients to Assess Risk of Cardiac Arrest or Arrhythmic Death.
- Authors
Verrier, Richard L.; Nearing, Bruce D.; Rovere, Maria Teresa La; Pinna, Gian Domenico; Mittleman, Murray A.; Bigger, J. Thomas; Schwartz, Peter J.
- Abstract
TWA and Post-MI Arrhythmia. Introduction: This is the first study to assess T wave alternans (TWA) analyzed from routine ambulatory electrocardiograms (AECGs) to identify postmyocardial infarction (post-MI) patients at increased risk for arrhythmic events. Methods and Results: The new method of modified moving average (MMA) analysis was used to measure TWA magnitude in 24-hour AECGs from ATRAMI, a prospective study of 1,284 post-MI patients. Using a nested case-control approach, we defined cases as patients who experienced cardiac arrest due to documented ventricular fibrillation or arrhythmic death during the follow-up period of 21 ± 8 months . We analyzed 15 cases and 29 controls matched for sex, age, site of MI, left ventricular ejection fraction, thrombolysis, and beta-blockade therapy. TWA was reported as the maximum 15-second value at three predetermined times associated with cardiovascular stress: maximum heart rate, 8:00 A.M., and maximum ST segment deviation. TWA increased significantly from baseline in both leads at each time point (P ≪ 0.01) in cases and controls. TWA in V[sub 5] increased more in cases than controls during peak heart rate (P = 0.005) and at 8:00 A.M. (P = 0.02) . A 4- to 7-fold higher odds of life-threatening arrhythmias was predicted by TWA level above the 75th percentile during maximum heart rate in leads V[sub 1] (odds ratio [OR] 4.2, 95% confidence interval [CI]: 1.1–16.3, P = 0.04 ) and V[sub 5] (OR 7.9, 95% CI: 1.9–33.1, P = 0.005) . TWA at 8:00 A.M. also predicted risk in leads V[sub 1] (OR = 5.0, 95% CI: 1.2–20.5, P = 0.02) and V[sub 5] (OR = 4.2, 95% CI: 1.1–16.3, P = 0.04) . Conclusion: TWA measurement from routine 24-hour AECGs is a promising approach for risk stratification for cardiac arrest and arrhythmic death in relatively low-risk post-MI patients. (J Cardiovasc Electrophysiol, Vol. 14, pp. 705-711, July 2003).
- Subjects
HEART diseases; ELECTROCARDIOGRAPHY; MYOCARDIAL infarction; CARDIAC arrest; VENTRICULAR fibrillation; THROMBOLYTIC therapy
- Publication
Journal of Cardiovascular Electrophysiology, 2003, Vol 14, Issue 7, p705
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1046/j.1540-8167.2003.03118.x