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Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction

A prospective study

^a Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan

View larger version (52K): [in a new window]   Figure 1 Individual ECG tracings in 15 patients revealing the occurrence of spontaneous, sustained ventricular arrhythmias. These tracings were recorded by any standard 12-lead ECG (patients 1–3, 5, 7–13, 15), conventional monitor ECG recorders (patients 4, 6), or 24-h Holter monitoring (patient 14). II indicates lead II in standard 12-lead ECGs, and CC5 indicates lead CC5 in Holter monitoring. Patient number corresponds to the number in Table 2.

View larger version (58K): [in a new window]   Figure 2 Holter recording revealing spontaneous onset and termination of sustained ventricular tachycardia documented in Patient 14. NASA and CC5 indicate lead NASA and CC5, respectively, in Holter monitoring.

View larger version (31K): [in a new window]   Figure 3 Representative data for a patient with a typical microvolt alternans of the T wave during exercise testing. Alternans analysis for leads VM, X, Y, Z, and V4 is shown. The dark shaded areas for each lead indicate regions for which the Valt has a Ralt 3 SD above the level of noise. Dark shaded areas, which also have %Bad, RPM, Resp and HR Delta indices in the acceptable range, are indicated by a black line along the time axis. In this representative patient, the Valt is 8.8 µV and the Ralt is 759 for lead Z. The alternans increased as the heart rate increased. HR, heart rate trend; %Bad, percentage of beats more than 10% premature; Noise, mean noise in lead VM; eVM, eX, eY, eZ, eV4, enhanced VM, X, Y, Z, and V4 leads; RPM, bicycle ergometer pedaling rate during exercise; Resp, respiratory frequency (0.25 cycles/beat); HR Delta, the difference between the highest and lowest instantaneous heart rates for a 128-consecutive beat interval; RR Alternans, the amplitude of RR interval alternans.

View larger version (21K): [in a new window]   Figure 4 Kaplan-Meier actuarial curves for arrhythmic event-free rates based on positive or negative for T-wave alternans (TWA) (A), late potentials (B), and the combination of the two noninvasive tests (C) following acute myocardial infarction. The combination of TWA positive and LP positive had poorer event-free (p < 0.0001) than the other.