Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy

Eran S. Zacks, Daniel P. Morin, Shaun Ageno, Matthew Janik, Andreas C. Mauer, Steven M. Markowitz, Suneet Mittal, Sei Iwai, Bindi K. Shah, Bruce B. Lerman, Kenneth M. Stein

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    20 Scopus citations

    Abstract

    Background: Prior investigation has shown that intravenous β-blockers decrease T-wave alternans (TWA) positivity in patients undergoing electrophysiology study (EPS). The present study examined whether oral β-blocker use within 24 hours of TWA influences yield and predictive value of TWA and EPS. Methods: We prospectively evaluated 387 patients (312 [81%] men, mean age 67 ± 11 years) with coronary artery disease, left ventricular ejection fraction ≤40%, and nonsustained ventricular tachycardia who underwent EPS and were followed for a mean of 2.8 ± 1.4 years. T-Wave alternans was performed using an atrial pacing protocol and interpreted using standard criteria. β-Blocker status was determined based on oral β-blocker use in the 24 hours preceding the test: β-blocker (-) (n = 62), β-blocker (+) (n = 325). Follow-up for ventricular tachycardia, ventricular fibrillation, and death was obtained from chart review, device interrogation, and the Social Security Death Index. Estimated sensitivity and specificity of TWA and EPS stratified by β-blocker use were calculated based on event-free 2-year survival. Results: There was no difference in EPS (31 [50%] inducible off β-blockers vs 166 [51%] on β-blockers [P = .89]) or TWA (26 [42%] positive, 17 [27%] indeterminate off β-blockers vs 136 [42%] positive, 81 [25%] indeterminate on β-blockers [P = .89]). β-Blocker use within 24 hours of testing did not affect the predictive value of TWA or EPS for overall or 2-year event-free survival. Conclusions: Oral β-blocker therapy appears to have no effect on yield or predictive value of EPS or TWA in patients with coronary artery disease, diminished left ventricular function, and a history of nonsustained ventricular tachycardia.

    Original languageEnglish (US)
    Pages (from-to)392-397
    Number of pages6
    JournalAmerican heart journal
    Volume153
    Issue number3
    DOIs
    StatePublished - Mar 2007

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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    Zacks, E. S., Morin, D. P., Ageno, S., Janik, M., Mauer, A. C., Markowitz, S. M., Mittal, S., Iwai, S., Shah, B. K., Lerman, B. B., & Stein, K. M. (2007). Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy. American heart journal, 153(3), 392-397. https://doi.org/10.1016/j.ahj.2006.12.010