Abstract
Several studies have recently proven that primary preventive therapy of sudden arrhythmogenic death is possible in selected patients with congestive heart failure, particularly in the setting of ischemic cardiomyopathy [1, 2]. However, a number needed to treat between 11 and 17 to save one life over three years in these studies indicates that a more accurate identification of high risk patients is desirable in order to avoid unnecessary implants of cardioverter/defibrillators (ICD). Since currently available risk stratification methods have limited predictive accuracy, development of new techniques is important in order to non-invasively assess arrhythmogenic risk in patients prone to sudden death. Microvolt level T-wave alternans (mTWA) has recently been proposed to assess abnormalities in ventricular repolarization favoring the occurrence of reentrant arrhythmias [3, 4]. In 1994, a first clinical study by Rosenbaum and coworkers [5] convincingly demonstrated that mTWA is closely related to arrhythmia induction in the electrophysiology (EP) laboratory as well as to the occurrence of spontaneous ventricular tachyarrhythmias during follow-up [5]. More recently, a number of clinical studies has examined its clinical applicability [4-7]. The present review summarizes currently available clinical data on TWA with a particular focus on risk stratifying patients with congestive heart failure and myocardial infarction.
Published Version
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