Intracardiac electrogram T-wave alternans/variability increases before spontaneous ventricular tachyarrhythmias in implantable cardioverter- defibrillator patients

A prospective, multi-center study

Charles Swerdlow, Theodore Chow, Mithilesh Das, Anne M. Gillis, Xiaohong Zhou, Athula Abeyratne, Raja N. Ghanem

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background-T-wave alternans (TWA) increases before ventricular tachycardia (VT) or fibrillation (VF), suggesting that it may warn of VT/VF in implantable cardioverter-defibrillator patients. Recently, we described a method for measuring alternans and nonalternans variability (TWA/V) from electrograms (EGMs) stored in implantable cardioverter-defibrillators before VT/VF. The goal of this prospective, multicenter study was to determine whether EGM TWA/V was greater before VT/VF than at baseline. Methods and Results-We enrolled 63 implantable cardioverter-defibrillator patients. TWA/V was computed from stored EGMs before spontaneous VT/VF and from sequential windows of 8 pairs of beats using 4 different control recordings: baseline rhythm, rapid pacing at 105 bpm, segments of ambulatory Holter EGMs matched to the time of VT/VF episodes, and EGMs before spontaneous supraventricular tachycardia. During follow-up, 28 patients had 166 episodes of VT/VF. TWA/V was greater before VT/VF (62.9±3.1 μV; n=28) than during baseline rhythm (12.8±1.8 μV; P<0.0001; n=62), during rapid pacing (14.5±2.0 μV; P<0.0001; n=52), before supraventricular tachycardia (27.5±6.1 μV; P<0.0001; n=9), or during time-matched ambulatory controls (12.3±3.5 μV; P<0.0001; n=16). By logistic regression, the odds of VT/VF increased by a factor of 2.2 for each 10-μV increment in TWA/V (P<0.0001). Conclusions-In implantable cardioverter-defibrillator patients, EGM TWA/V is greater before spontaneous VT/VF than in control recordings. Future implantable cardioverter-defibrillators that measure EGM TWA/V continuously may warn patients and initiate pacing therapies to prevent VT/VF.

Original languageEnglish
Pages (from-to)1052-1060
Number of pages9
JournalCirculation
Volume123
Issue number10
DOIs
StatePublished - Mar 15 2011

Fingerprint

Cardiac Electrophysiologic Techniques
Implantable Defibrillators
Ventricular Fibrillation
Ventricular Tachycardia
Tachycardia
Supraventricular Tachycardia
Multicenter Studies
Logistic Models

Keywords

  • implantable cardioverter defibrillator
  • T-wave alternans
  • tachyarrhythmias

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Intracardiac electrogram T-wave alternans/variability increases before spontaneous ventricular tachyarrhythmias in implantable cardioverter- defibrillator patients : A prospective, multi-center study. / Swerdlow, Charles; Chow, Theodore; Das, Mithilesh; Gillis, Anne M.; Zhou, Xiaohong; Abeyratne, Athula; Ghanem, Raja N.

In: Circulation, Vol. 123, No. 10, 15.03.2011, p. 1052-1060.

Research output: Contribution to journalArticle

Swerdlow, Charles ; Chow, Theodore ; Das, Mithilesh ; Gillis, Anne M. ; Zhou, Xiaohong ; Abeyratne, Athula ; Ghanem, Raja N. / Intracardiac electrogram T-wave alternans/variability increases before spontaneous ventricular tachyarrhythmias in implantable cardioverter- defibrillator patients : A prospective, multi-center study. In: Circulation. 2011 ; Vol. 123, No. 10. pp. 1052-1060.
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abstract = "Background-T-wave alternans (TWA) increases before ventricular tachycardia (VT) or fibrillation (VF), suggesting that it may warn of VT/VF in implantable cardioverter-defibrillator patients. Recently, we described a method for measuring alternans and nonalternans variability (TWA/V) from electrograms (EGMs) stored in implantable cardioverter-defibrillators before VT/VF. The goal of this prospective, multicenter study was to determine whether EGM TWA/V was greater before VT/VF than at baseline. Methods and Results-We enrolled 63 implantable cardioverter-defibrillator patients. TWA/V was computed from stored EGMs before spontaneous VT/VF and from sequential windows of 8 pairs of beats using 4 different control recordings: baseline rhythm, rapid pacing at 105 bpm, segments of ambulatory Holter EGMs matched to the time of VT/VF episodes, and EGMs before spontaneous supraventricular tachycardia. During follow-up, 28 patients had 166 episodes of VT/VF. TWA/V was greater before VT/VF (62.9±3.1 μV; n=28) than during baseline rhythm (12.8±1.8 μV; P<0.0001; n=62), during rapid pacing (14.5±2.0 μV; P<0.0001; n=52), before supraventricular tachycardia (27.5±6.1 μV; P<0.0001; n=9), or during time-matched ambulatory controls (12.3±3.5 μV; P<0.0001; n=16). By logistic regression, the odds of VT/VF increased by a factor of 2.2 for each 10-μV increment in TWA/V (P<0.0001). Conclusions-In implantable cardioverter-defibrillator patients, EGM TWA/V is greater before spontaneous VT/VF than in control recordings. Future implantable cardioverter-defibrillators that measure EGM TWA/V continuously may warn patients and initiate pacing therapies to prevent VT/VF.",
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AU - Chow, Theodore

AU - Das, Mithilesh

AU - Gillis, Anne M.

AU - Zhou, Xiaohong

AU - Abeyratne, Athula

AU - Ghanem, Raja N.

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N2 - Background-T-wave alternans (TWA) increases before ventricular tachycardia (VT) or fibrillation (VF), suggesting that it may warn of VT/VF in implantable cardioverter-defibrillator patients. Recently, we described a method for measuring alternans and nonalternans variability (TWA/V) from electrograms (EGMs) stored in implantable cardioverter-defibrillators before VT/VF. The goal of this prospective, multicenter study was to determine whether EGM TWA/V was greater before VT/VF than at baseline. Methods and Results-We enrolled 63 implantable cardioverter-defibrillator patients. TWA/V was computed from stored EGMs before spontaneous VT/VF and from sequential windows of 8 pairs of beats using 4 different control recordings: baseline rhythm, rapid pacing at 105 bpm, segments of ambulatory Holter EGMs matched to the time of VT/VF episodes, and EGMs before spontaneous supraventricular tachycardia. During follow-up, 28 patients had 166 episodes of VT/VF. TWA/V was greater before VT/VF (62.9±3.1 μV; n=28) than during baseline rhythm (12.8±1.8 μV; P<0.0001; n=62), during rapid pacing (14.5±2.0 μV; P<0.0001; n=52), before supraventricular tachycardia (27.5±6.1 μV; P<0.0001; n=9), or during time-matched ambulatory controls (12.3±3.5 μV; P<0.0001; n=16). By logistic regression, the odds of VT/VF increased by a factor of 2.2 for each 10-μV increment in TWA/V (P<0.0001). Conclusions-In implantable cardioverter-defibrillator patients, EGM TWA/V is greater before spontaneous VT/VF than in control recordings. Future implantable cardioverter-defibrillators that measure EGM TWA/V continuously may warn patients and initiate pacing therapies to prevent VT/VF.

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