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

Research output: Contribution to journalArticle

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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
Externally publishedYes

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Electrophysiology
Cardiomyopathies
Ventricular Tachycardia
Therapeutics
Coronary Artery Disease
Social Security
Ventricular Fibrillation
Left Ventricular Function
Stroke Volume
Disease-Free Survival
Sensitivity and Specificity
Equipment and Supplies
Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy. / Zacks, Eran S.; Morin, Daniel P.; Ageno, Shaun; Janik, Matthew; Mauer, Andreas C.; Markowitz, Steven M.; Mittal, Suneet; Iwai, Sei; Shah, Bindi K.; Lerman, Bruce B.; Stein, Kenneth M.

In: American Heart Journal, Vol. 153, No. 3, 03.2007, p. 392-397.

Research output: Contribution to journalArticle

Zacks, ES, Morin, DP, Ageno, S, Janik, M, Mauer, AC, Markowitz, SM, Mittal, S, Iwai, S, Shah, BK, Lerman, BB & Stein, KM 2007, 'Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy', American Heart Journal, vol. 153, no. 3, pp. 392-397. https://doi.org/10.1016/j.ahj.2006.12.010
Zacks, Eran S. ; Morin, Daniel P. ; Ageno, Shaun ; Janik, Matthew ; Mauer, Andreas C. ; Markowitz, Steven M. ; Mittal, Suneet ; Iwai, Sei ; Shah, Bindi K. ; Lerman, Bruce B. ; Stein, Kenneth M. / Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy. In: American Heart Journal. 2007 ; Vol. 153, No. 3. pp. 392-397.
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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.",
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T1 - Effect of oral β-blocker therapy on microvolt T-wave alternans and electrophysiology testing in patients with ischemic cardiomyopathy

AU - Zacks, Eran S.

AU - Morin, Daniel P.

AU - Ageno, Shaun

AU - Janik, Matthew

AU - Mauer, Andreas C.

AU - Markowitz, Steven M.

AU - Mittal, Suneet

AU - Iwai, Sei

AU - Shah, Bindi K.

AU - Lerman, Bruce B.

AU - Stein, Kenneth M.

PY - 2007/3

Y1 - 2007/3

N2 - 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.

AB - 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.

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