In-Hospital Heart Rate Turbulence and Microvolt T-Wave Alternans Abnormalities for Prediction of Early Life-Threatening Ventricular Arrhythmia after Acute Myocardial Infarction

Authors

  • Mohamed Moussa Arisha M.D.,

    1. Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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    • The first and second author contributed equally to the manuscript.

  • Nicolas Girerd M.D., M.Sc.,

    1. Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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    • The first and second author contributed equally to the manuscript.

  • Samuel Chauveau M.D.,

    1. Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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  • Didier Bresson M.D.,

    1. Intensive Care Unit, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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  • Alina Scridon M.D.,

    1. Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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  • Eric Bonnefoy M.D., Ph.D.,

    1. Intensive Care Unit, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
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  • Philippe Chevalier M.D., Ph.D.

    Corresponding author
    1. Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, Lyon, France
    • Address for correspondence: Philippe Chevalier, Service de Rythmologie, Hôpital cardiologique Louis-Pradel, 59 bd Pinel, 69677 BRON Cedex, France. Fax: 33 4 72 35 73 41; E-mail: philippe.chevalier@chu-lyon.fr

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  • Funding/Disclosure: None.

  • [Correction added on 06 November 2013, after first online publication: The title has been amended from “Microwave T-Wave Alternans Abnormalities” to “Microvolt T-Wave Alternans Abnormalities”.]

Abstract

Background

In the setting of primary prevention, most implantable cardiac defibrillators (ICD) are implanted more than 6 months after acute myocardial infarction (AMI). Abnormal heart rate turbulence (HRT) and T-wave alternans (TWA) are predictors of long-term sudden cardiac death (SCD). We intended to assess the predictive value of HRT and TWA for early post-AMI SCD and life-threatening ventricular arrhythmias (VA).

Methods

One hundred ninety-nine consecutive patients with AMI were prospectively included (age 61.7 years, LV ejection fraction 45%). One hundred eighty-three patients (92%) underwent percutaneous coronary intervention. We assessed HRT using turbulence slope (TS), turbulence onset (TO), and TWA on channels 1 and 2 (TWA1 and TWA2) using the modified moving average method. Predictive performance for SCD/VA was assessed by area under the receiver operating curve characteristic (ROC-AUC).

Results

Within 6 months after AMI, 2 patients (1%) developed life-threatening VA and 3 (1.5%) experienced SCD. TO and TWA1 had poor ROC-AUC (both 0.64) whereas TS and TWA2 failed to show any predictive performance (ROC-AUC 0.48 and 0.57, respectively). When combining TO and TWA1, ROC-AUC increased to 0.80. Importantly, when considering the subset of patients with a LV ejection fraction ≤40%, the combined variable of TO and TWA1 remained strongly predictive of a short-term event (ROC-AUC 0.86).

Conclusions

Combined assessment of HRT and TWA showed a high predictive performance for SCD or life-threatening VA within 6 months after AMI. This combined Holter ECG index could be useful to identify high-risk patients who might benefit from early ICD implantation.

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