Predictive Value of Microvolt T-Wave Alternans in Patients With Left Ventricular Dysfunction

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

Research output: Contribution to journalArticlepeer-review

63 Scopus citations


Objectives: The purpose of this study was to prospectively evaluate the utility of microvolt T-wave alternans (TWA) in predicting arrhythmia-free survival and total mortality in patients with left ventricular (LV) dysfunction. Background: Microvolt TWA has been proposed as a useful tool in identifying patients unlikely to benefit from prophylaxis with implantable cardioverter-defibrillator (ICD) prophylaxis. Methods: We evaluated 286 patients with an LV ejection fraction ≤35% who underwent TWA and electrophysiologic testing (EPS) owing to nonsustained ventricular tachycardia and/or syncope. Positive and indeterminate TWA results were grouped as non-negative. The primary end point was arrhythmia-free survival; the secondary end point was all-cause mortality. Results: Patients were followed for a mean of 38 ± 11 months. There was no significant difference between the TWA-negative (n = 90; 31%) and non-negative (n = 196; 69%) groups with respect to ICD implant rates (54% vs. 64%, respectively; p = 0.95) or etiology of cardiomyopathy (ischemic: 73% vs. 76%; p = 0.71). The Kaplan-Meier curves demonstrated improved arrhythmia-free survival in TWA-negative patients (81% vs. 66% at 2 years; p < 0.001), including in both ischemic (79% vs. 64% at 2 years; p = 0.004) and nonischemic (88% vs. 71% at 2 years; p = 0.015) subgroups. Total mortality was lower in the TWA-negative group (10% vs. 18% at 2 years; p = 0.04). The negative predictive value of TWA for (2-year) total mortality was 90%, and 83% for EPS. Conclusion: Microvolt TWA predicts arrhythmia-free survival among patients with LV dysfunction. However, the event rate in the TWA-negative group suggests that TWA may not be capable of identifying a sufficiently low-risk subset in this population to obviate the need for ICD implantation.

Original languageEnglish (US)
Pages (from-to)166-173
Number of pages8
JournalJournal of the American College of Cardiology
Issue number2
StatePublished - Jul 10 2007
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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