Predicting sudden cardiac death from T wave alternans of the surface electrocardiogram: promise and pitfalls.
Sudden cardiac death remains a preeminent public health problem. Despite advances in preventative treatment for patients known to be at risk, to date we have been able to identify, and thus treat, only a small minority of these patients. Therefore, there is a major need to develop noninvasive diagnostic technologies to identify patients at risk. Recent studies have demonstrated that measurement of microvolt-level T wave alternans is a promising technique for the accurate identification of patients at risk for ventricular arrhythmias and sudden cardiac death. In this article, we review the clinical data establishing the relationship between microvolt T wave alternans and susceptibility to ventricular arrhythmias. We also review the methods and technology that have been developed to measure microvolt levels of T wave alternans noninvasively in broad populations of ambulatory patients. In particular, we examine techniques that permit the accurate measurement of T wave alternans during exercise stress testing.
Rosenbaum
D S
DS
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Albrecht
P
P
Cohen
R J
RJ
D016477:Artifacts; D003645:Death, Sudden / Q000209:etiology*; D004562:Electrocardiography; D006339:Heart Rate; D006801:Humans