Microvolt T-wave alternans for risk stratification in athletes with ventricular arrhythmias: correlation with programmed ventricular stimulation.
BACKGROUND
Aim of our study is to evaluate the role of T-wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results.


METHODS
We studied 85 Ath with VA (61 M, mean age 32 +/- 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow-up of 30 +/- 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT).


RESULTS
TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow-up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS.


CONCLUSIONS
TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.
Inama
Giuseppe
G
Department of Cardiology, Ospedale Maggiore, Crema, Italy. g.inama@hcrema.it
Pedrinazzi
Claudio
C
Durin
Ornella
O
Nanetti
Massimiliano
M
Donato
Giorgio
G
Pizzi
Rita
R
Assanelli
Deodato
D
D000328:Adult; D016757:Death, Sudden, Cardiac / Q000209:etiology; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D013177:Sports / Q000706:statistics & numerical data*; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology*