T-wave alternans testing for ventricular arrhythmias.
T-wave alterans (TWA) measures alternate-beat fluctuations in the ECG T-wave, and has been used to predict the risk for life-threatening ventricular arrhythmias in various clinical populations. This work reviews the traditional literature linking repolarization alternans in cellular and tissue-level studies, with clinical studies that TWA can successfully add to existing clinical risk factors in predicting ventricular arrhythmias. We conclude by providing an evidence-based framework integrating TWA with other risk factors to stratify risk for sudden cardiac arrest.
Narayan
Sanjiv M
SM
University of California and VA Medical Center, La Jolla, CA, USA. snarayan@ucsd.edu
D000200:Action Potentials; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
Circulation. 1977 Apr;55(4):574-7
837498
J Appl Physiol (1985). 2002 Feb;92(2):541-9
11796662
J Appl Physiol (1985). 2007 Apr;102(4):1462-8
17158246
Eur Heart J. 2007 Oct;28(19):2332-7
17652105
J Am Coll Cardiol. 2006 Sep 5;48(5):e247-346
16949478
J Cardiovasc Electrophysiol. 2002 Sep;13(9):845-50
12380918
J Am Coll Cardiol. 2006 Oct 3;48(7):1399-404
17010802
J Cardiovasc Electrophysiol. 2002 Nov;13(11):1141-9
12475106
J Am Coll Cardiol. 2007 Sep 18;50(12):1150-7
17868806
Circ Res. 2006 May 26;98(10):1244-53
16728670
Chest. 1972 Sep;62(3):319-21
5056591
N Engl J Med. 1992 Jan 23;326(4):271-2
1727982
N Engl J Med. 1994 Jan 27;330(4):235-41
8272084
J Am Coll Cardiol. 2005 Jul 5;46(1):75-82
15992639
Circulation. 2002 Oct 8;106(15):1968-73
12370221
Heart Rhythm. 2005 Mar;2(3):234-41
15851310
J Electrocardiol. 1984 Jul;17(3):229-38
6207256
Circulation. 2002 Feb 19;105(7):837-42
11854124
J Am Coll Cardiol. 2000 Dec;36(7):2247-53
11127468
Pacing Clin Electrophysiol. 2007 Jan;30 Suppl 1:S178-82
17302700
Circ Res. 2004 Apr 30;94(8):1083-90
15016735
Circ Res. 1998 Sep 21;83(6):614-28
9742057
Am Heart J. 2007 Mar;153(3):392-7
17307418
Circulation. 2005 Sep 13;112(11):1542-8
16157783
J Am Coll Cardiol. 2006 Jan 17;47(2):269-81
16412847
J Am Coll Cardiol. 2007 Dec 18;50(25):2385-92
18154963
Pacing Clin Electrophysiol. 2007 Mar;30(3):352-8
17367354
Am J Cardiol. 2003 Oct 15;92(8):998-1001
14556884
J Cardiovasc Electrophysiol. 2002 May;13(5):502-12
12030535
Am J Cardiol. 2006 Mar 15;97(6):775-80
16516574
Circulation. 2003 Dec 9;108(23):2883-91
14623812
J Am Coll Cardiol. 2000 May;35(6):1485-92
10807451
J Cardiovasc Electrophysiol. 2002 Aug;13(8):770-5
12212695
N Engl J Med. 2005 Jan 20;352(3):225-37
15659722
J Am Coll Cardiol. 2007 Jan 2;49(1):50-8
17207722
N Engl J Med. 2002 Mar 21;346(12):877-83
11907286
J Am Coll Cardiol. 2007 Jan 23;49(3):338-46
17239715
Circulation. 1999 Nov 2;100(18):1887-93
10545433
Circulation. 2004 Oct 5;110(14):1885-9
15451804
Heart Rhythm. 2005 Dec;2(12):1383-6
16360097
J Am Coll Cardiol. 2006 Dec 5;48(11):2268-74
17161258
Circulation. 1996 Oct 15;94(8):1996-2012
8873679
Circulation. 1999 Mar 16;99(10):1385-94
10077525
J Am Coll Cardiol. 2006 Jan 17;47(2):456-63
16412877
J Cardiovasc Electrophysiol. 2004 Feb;15(2):170-6
15028046
Circulation. 1988 Jan;77(1):110-21
3335062
Am J Cardiol. 1966 Aug;18(2):200-7
5916312
J Am Coll Cardiol. 2000 Mar 1;35(3):722-30
10716476
Lancet. 2003 Jul 12;362(9378):125-6
12867114
Am J Cardiol. 1984 Jan 15;53(2):390-1
6695758
Pacing Clin Electrophysiol. 2005 Jan;28 Suppl 1:S193-7
15683495
Circulation. 2001 Oct 30;104(18):2158-63
11684624
Eur J Heart Fail. 2007 May;9(5):502-9
17174599
Heart Rhythm. 2007 Jul;4(7):904-12
17599676