T wave alternans as a predictor of spontaneous ventricular tachycardia in a canine model of sudden cardiac death

Jerome Tsai, Ji Min Cao, Shengmei Zhou, Moshe Swissa, Adam W. Cates, Bruce H. Kenknight, Lan Chen, Hrayr S. Karagueuzian, Peng-Sheng Chen

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Introduction: We recently developed an ambulatory canine model of spontaneous ventricular tachycardia (VT) and sudden cardiac death by creating myocardial infarction, complete AV block, and infusion of nerve growth factor to the left stellate ganglion. Whether or not T wave alternans is associated with the spontaneously occurring episodes of VT in our model was unclear. Methods and Results: Through intracardiac electrograms obtained from an implantable cardioverter defibrillator, we manually measured T wave amplitudes prior to VT and while the dogs were at rest (baseline, no VT). Of the 79 VT episodes analyzed, 28 (35.4%) exhibited repolarization alternans. In contrast, only 3 (4.7%) of 64 baseline data cases displayed alternans (P <0.0001). The magnitude of T wave alternans for dogs that died of sudden cardiac death, dogs that did not die suddenly, and for the total 28 episodes that exhibited repolarization alternans were 4.8 ± 2.8 mm, 4.9 ± 3.5 mm, and 4.9 ± 3.3 mm, respectively (P = NS). We also found the sensitivity, specificity, positive predictive value, negative predictive value, and relative risk of repolarization alternans in predicting VT to be 35.4%, 95.3%, 90.3%, 54.5%, and 1.98, respectively. The ventricular rate prior to VT (65 ± 11 beats/min) was significantly higher than that at rest (49 ± 12 beats/min; P <0.0001). Conclusion: T wave alternans often occurred immediately before the onset of VT in dogs with myocardial infarction, complete AV block, and nerve growth factor infusion to the left stellate ganglion. Increased sympathetic activity might be responsible for the occurrence of the T wave alternans.

Original languageEnglish (US)
Pages (from-to)51-55
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume13
Issue number1
StatePublished - 2002
Externally publishedYes

Fingerprint

Sudden Cardiac Death
Ventricular Tachycardia
Canidae
Dogs
Stellate Ganglion
Atrioventricular Block
Nerve Growth Factor
Myocardial Infarction
Cardiac Electrophysiologic Techniques
Implantable Defibrillators
Sensitivity and Specificity

Keywords

  • Arrhythmia
  • Heart block
  • Long QT syndrome
  • Myocardial infarction
  • Remodeling

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

T wave alternans as a predictor of spontaneous ventricular tachycardia in a canine model of sudden cardiac death. / Tsai, Jerome; Cao, Ji Min; Zhou, Shengmei; Swissa, Moshe; Cates, Adam W.; Kenknight, Bruce H.; Chen, Lan; Karagueuzian, Hrayr S.; Chen, Peng-Sheng.

In: Journal of Cardiovascular Electrophysiology, Vol. 13, No. 1, 2002, p. 51-55.

Research output: Contribution to journalArticle

Tsai, J, Cao, JM, Zhou, S, Swissa, M, Cates, AW, Kenknight, BH, Chen, L, Karagueuzian, HS & Chen, P-S 2002, 'T wave alternans as a predictor of spontaneous ventricular tachycardia in a canine model of sudden cardiac death', Journal of Cardiovascular Electrophysiology, vol. 13, no. 1, pp. 51-55.
Tsai, Jerome ; Cao, Ji Min ; Zhou, Shengmei ; Swissa, Moshe ; Cates, Adam W. ; Kenknight, Bruce H. ; Chen, Lan ; Karagueuzian, Hrayr S. ; Chen, Peng-Sheng. / T wave alternans as a predictor of spontaneous ventricular tachycardia in a canine model of sudden cardiac death. In: Journal of Cardiovascular Electrophysiology. 2002 ; Vol. 13, No. 1. pp. 51-55.
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abstract = "Introduction: We recently developed an ambulatory canine model of spontaneous ventricular tachycardia (VT) and sudden cardiac death by creating myocardial infarction, complete AV block, and infusion of nerve growth factor to the left stellate ganglion. Whether or not T wave alternans is associated with the spontaneously occurring episodes of VT in our model was unclear. Methods and Results: Through intracardiac electrograms obtained from an implantable cardioverter defibrillator, we manually measured T wave amplitudes prior to VT and while the dogs were at rest (baseline, no VT). Of the 79 VT episodes analyzed, 28 (35.4{\%}) exhibited repolarization alternans. In contrast, only 3 (4.7{\%}) of 64 baseline data cases displayed alternans (P <0.0001). The magnitude of T wave alternans for dogs that died of sudden cardiac death, dogs that did not die suddenly, and for the total 28 episodes that exhibited repolarization alternans were 4.8 ± 2.8 mm, 4.9 ± 3.5 mm, and 4.9 ± 3.3 mm, respectively (P = NS). We also found the sensitivity, specificity, positive predictive value, negative predictive value, and relative risk of repolarization alternans in predicting VT to be 35.4{\%}, 95.3{\%}, 90.3{\%}, 54.5{\%}, and 1.98, respectively. The ventricular rate prior to VT (65 ± 11 beats/min) was significantly higher than that at rest (49 ± 12 beats/min; P <0.0001). Conclusion: T wave alternans often occurred immediately before the onset of VT in dogs with myocardial infarction, complete AV block, and nerve growth factor infusion to the left stellate ganglion. Increased sympathetic activity might be responsible for the occurrence of the T wave alternans.",
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T1 - T wave alternans as a predictor of spontaneous ventricular tachycardia in a canine model of sudden cardiac death

AU - Tsai, Jerome

AU - Cao, Ji Min

AU - Zhou, Shengmei

AU - Swissa, Moshe

AU - Cates, Adam W.

AU - Kenknight, Bruce H.

AU - Chen, Lan

AU - Karagueuzian, Hrayr S.

AU - Chen, Peng-Sheng

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N2 - Introduction: We recently developed an ambulatory canine model of spontaneous ventricular tachycardia (VT) and sudden cardiac death by creating myocardial infarction, complete AV block, and infusion of nerve growth factor to the left stellate ganglion. Whether or not T wave alternans is associated with the spontaneously occurring episodes of VT in our model was unclear. Methods and Results: Through intracardiac electrograms obtained from an implantable cardioverter defibrillator, we manually measured T wave amplitudes prior to VT and while the dogs were at rest (baseline, no VT). Of the 79 VT episodes analyzed, 28 (35.4%) exhibited repolarization alternans. In contrast, only 3 (4.7%) of 64 baseline data cases displayed alternans (P <0.0001). The magnitude of T wave alternans for dogs that died of sudden cardiac death, dogs that did not die suddenly, and for the total 28 episodes that exhibited repolarization alternans were 4.8 ± 2.8 mm, 4.9 ± 3.5 mm, and 4.9 ± 3.3 mm, respectively (P = NS). We also found the sensitivity, specificity, positive predictive value, negative predictive value, and relative risk of repolarization alternans in predicting VT to be 35.4%, 95.3%, 90.3%, 54.5%, and 1.98, respectively. The ventricular rate prior to VT (65 ± 11 beats/min) was significantly higher than that at rest (49 ± 12 beats/min; P <0.0001). Conclusion: T wave alternans often occurred immediately before the onset of VT in dogs with myocardial infarction, complete AV block, and nerve growth factor infusion to the left stellate ganglion. Increased sympathetic activity might be responsible for the occurrence of the T wave alternans.

AB - Introduction: We recently developed an ambulatory canine model of spontaneous ventricular tachycardia (VT) and sudden cardiac death by creating myocardial infarction, complete AV block, and infusion of nerve growth factor to the left stellate ganglion. Whether or not T wave alternans is associated with the spontaneously occurring episodes of VT in our model was unclear. Methods and Results: Through intracardiac electrograms obtained from an implantable cardioverter defibrillator, we manually measured T wave amplitudes prior to VT and while the dogs were at rest (baseline, no VT). Of the 79 VT episodes analyzed, 28 (35.4%) exhibited repolarization alternans. In contrast, only 3 (4.7%) of 64 baseline data cases displayed alternans (P <0.0001). The magnitude of T wave alternans for dogs that died of sudden cardiac death, dogs that did not die suddenly, and for the total 28 episodes that exhibited repolarization alternans were 4.8 ± 2.8 mm, 4.9 ± 3.5 mm, and 4.9 ± 3.3 mm, respectively (P = NS). We also found the sensitivity, specificity, positive predictive value, negative predictive value, and relative risk of repolarization alternans in predicting VT to be 35.4%, 95.3%, 90.3%, 54.5%, and 1.98, respectively. The ventricular rate prior to VT (65 ± 11 beats/min) was significantly higher than that at rest (49 ± 12 beats/min; P <0.0001). Conclusion: T wave alternans often occurred immediately before the onset of VT in dogs with myocardial infarction, complete AV block, and nerve growth factor infusion to the left stellate ganglion. Increased sympathetic activity might be responsible for the occurrence of the T wave alternans.

KW - Arrhythmia

KW - Heart block

KW - Long QT syndrome

KW - Myocardial infarction

KW - Remodeling

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