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Pathophysiological basis and clinical application of T-wave alternans

Antonis A. Armoundas, PhD^*,*, Gordon F. Tomaselli, MD^* and Hans D. Esperer, MD

^* Division of Molecular Cardiobiology, Johns Hopkins University, Baltimore, Maryland, USA
University Hospital, Division of Cardiology, Otto-von-Guericke University, Magdeburg, Germany

View larger version (14K): [in a new window]   Figure 1 Representative example of power spectrum of beat-to-beat fluctuations in T-wave morphology. The alternans ratio is the amplitude of the spectrum at the alternans frequency (alternans peak) minus the mean background noise level (noise), divided by the standard deviation of the noise (noise) in the reference noise band plots. Reproduced with permission from Armoundas et al. (99).

View larger version (14K): [in a new window]   Figure 2 The relation between T-wave alternans and arrhythmia-free survival in 66 patients is shown in the left panel. Kaplan-Meier life table arrhythmia-free survival compared patients with and without T-wave alternans. In the right panel, arrhythmia-free survival in patients with a positive electrophysiologic (EPS) study is compared to survival in patients in whom ventricular arrhythmias were not induced in EPS study. Note that the predictive values of EPS study and T-wave alternans are essentially indistinguishable in these plots. Reproduced with permission from Rosenbaum et al. (66).