title: Increased microvolt T-wave alternans in patients with repaired tetralogy of Fallot.
abstract: BACKGROUND
  Microvolt T wave alternans (MTWA) is an indicator of repolarization heterogeneity and a predictor of ventricular arrhythmia in adults with ischemic or dilated cardiomyopathy. Its implication in patients with repaired tetralogy of Fallot (TOF) is still unclear. This study sought to define the changes and the clinical implication of MTWA in these patients.
  
  
  METHODS
  Treadmill examination with modified moving average beat analysis (MMA) for MTWA was performed in 101 repaired TOF patients (60.4% male). Data from 103 age- and sex-matched subjects with normal hearts served as controls.
  
  
  RESULTS
  The age at latest follow-up was 20.0 ± 10.6 years. Total repair (60.4% received a transannular right ventricular outflow patch) was performed at a mean age of 4.8(± 5.8) years. After excluding 11 patients with indeterminate data, the MTWA data in 90 TOF patients revealed higher values than those in the control (25.1 ± 14.0 vs. 17.6 ± 9.2 μV, p<0.001). The values were best correlated to the presence of severe pulmonary regurgitation (p=0.006). Ten (9.9%) patients experienced late ventricular arrhythmic events. They tended to have higher MTWA values than those without (34.0 ± 16.5 vs. 24.2 ± 13.5 and p=0.053). Although the MTWA per se would not predict the late arrhythmia events better than QRS duration alone, the positive and negative predictive values increased slightly after adding the MTWA to QRS duration.
  
  
  CONCLUSIONS
  MTWA, as measured by MMA, increased in repaired TOF patients particularly in those with severe pulmonary regurgitation and late arrhythmia events. To predict late ventricular arrhythmia, MTWA however was not superior to QRS duration alone.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
authors.forename: Shuenn-Nan
authors.initials: SN
authors.lastname: Chiu
authors.forename: Hsin-Hui
authors.initials: HH
authors.lastname: Chiu
authors.forename: Jou-Kou
authors.initials: JK
authors.lastname: Wang
authors.forename: Ming-Tai
authors.initials: MT
authors.lastname: Lin
authors.forename: Chun-An
authors.initials: CA
authors.lastname: Chen
authors.forename: En-Ting
authors.initials: ET
authors.lastname: Wu
authors.forename: Chun-Wei
authors.initials: CW
authors.lastname: Lu
authors.forename: Mei-Hwan
authors.initials: MH
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D058067:Wavelet Analysis; D055815:Young Adult