HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.08.066v1 47/2/269    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (33) Citing Articles via Google Scholar Google Scholar Articles by Narayan, S. M. Search for Related Content PubMed PubMed Citation Articles by Narayan, S. M.

STATE-OF-THE-ART PAPER

T-Wave Alternans and the Susceptibility to Ventricular Arrhythmias

Sanjiv M. Narayan, MB, MD, FACC^_*,,_*

^_* University of California, San Diego
Veterans Affairs Medical Center, La Jolla, California.

Manuscript received May 9, 2005; revised manuscript received July 20, 2005, accepted August 1, 2005.

^_* Reprint requests and correspondence: Dr. Sanjiv M. Narayan, San Diego VA Healthcare System, University of California San Diego, Whitaker Institute for Biomedical Engineering, Cardiology, 111A, 3350 La Jolla Village Drive, San Diego, California 92161. (Email: snarayan{at}ucsd.edu).

T-wave alternans (TWA) reflects beat-to-beat fluctuations in the electrocardiographic T-wave, and is associated with dispersion of repolarization and the mechanisms for sudden cardiac arrest (SCA). This review examines the bench-to-bedside literature that, over decades, has linked alternans of repolarization in cellular, whole-heart, and human studies with spatial dispersion of repolarization, alternans of cellular action potential, and fluctuations in ionic currents that may lead to ventricular arrhythmias. Collectively, these studies provide a foundation for the clinical use of TWA to reflect susceptibility to ventricular arrhythmias in several disease states. This review then provides a contemporary evidence-based framework for the use of TWA to enhance risk stratification for SCA, identifying populations for whom TWA is best established, those for whom further studies are required, and areas for additional investigation.

Abbreviations and Acronyms   APD = action potential duration   DI = diastolic interval   ECG = electrocardiography   EPS = electrophysiologic study   HCM = hypertrophic cardiomyopathy   ICD = implantable cardioverter-defibrillator   LQTS = long QT syndrome   LV = left ventricular   LVEF = left ventricular ejection fraction   MADIT = Multicenter Automatic Defibrillator Trial   MASTERS = Microvolt T-wave Alternans Testing for Risk Stratification of post-MI patients   MI = myocardial infarction   MMA = Modified Moving Average   MUSTT = Multicenter Unsustained Tachycardia Trial   NICM = non-ischemic cardiomyopathy   RR = relative risk   SAECG = signal-averaged ECG   SCA = sudden cardiac arrest   TWA = T-wave alternans   VF = ventricular fibrillation   VT = ventricular tachycardia

This article has been cited by other articles:

				S. M. Narayan, M. R. Franz, G. Lalani, J. Kim, and A. Sastry T-Wave Alternans, Restitution of Human Action Potential Duration, and Outcome J. Am. Coll. Cardiol., December 18, 2007; 50(25): 2385 - 2392. [Abstract] [Full Text] [PDF]

				R. L. Verrier, K. Kumar, and M. E. Josephson The Frustrating Search for Arrhythmia Risk Stratifiers in Heart Failure Due to Nonischemic Cardiomyopathy: Does T-Wave Alternans Testing Help? J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1905 - 1906. [Full Text] [PDF]

				J. A. Salerno-Uriarte, G. M. De Ferrari, C. Klersy, R. F.E. Pedretti, M. Tritto, L. Sallusti, L. Libero, G. Pettinati, G. Molon, A. Curnis, et al. Prognostic Value of T-Wave Alternans in Patients With Heart Failure Due to Nonischemic Cardiomyopathy: Results of the ALPHA Study J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1896 - 1904. [Abstract] [Full Text] [PDF]

				T. Nieminen, T. Lehtimaki, J. Viik, R. Lehtinen, K. Nikus, T. Koobi, K. Niemela, V. Turjanmaa, W. Kaiser, H. Huhtala, et al. T-wave alternans predicts mortality in a population undergoing a clinically indicated exercise test Eur. Heart J., October 1, 2007; 28(19): 2332 - 2337. [Abstract] [Full Text] [PDF]

				V. E. Bondarenko and R. L. Rasmusson Simulations of propagated mouse ventricular action potentials: effects of molecular heterogeneity Am J Physiol Heart Circ Physiol, September 1, 2007; 293(3): H1816 - H1832. [Abstract] [Full Text] [PDF]

				L. M. Livshitz and Y. Rudy Regulation of Ca2+ and electrical alternans in cardiac myocytes: role of CAMKII and repolarizing currents Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2854 - H2866. [Abstract] [Full Text] [PDF]

				P. J. Zimetbaum A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator JAMA, May 2, 2007; 297(17): 1909 - 1916. [Abstract] [Full Text] [PDF]

				S. M. Narayan, D. D. Drinan, R. P. Lackey, and C. F. Edman Acute volume overload elevates T-wave alternans magnitude J Appl Physiol, April 1, 2007; 102(4): 1462 - 1468. [Abstract] [Full Text] [PDF]

				S. M. Narayan T-Wave Alternans and Human Ventricular Arrhythmias: What Is the Link? J. Am. Coll. Cardiol., January 23, 2007; 49(3): 347 - 349. [Full Text] [PDF]

				E. Picht, J. DeSantiago, L. A. Blatter, and D. M. Bers Cardiac Alternans Do Not Rely on Diastolic Sarcoplasmic Reticulum Calcium Content Fluctuations Circ. Res., September 29, 2006; 99(7): 740 - 748. [Abstract] [Full Text] [PDF]