The first and second author contributed equally to the manuscript.
In-Hospital Heart Rate Turbulence and Microvolt T-Wave Alternans Abnormalities for Prediction of Early Life-Threatening Ventricular Arrhythmia after Acute Myocardial Infarction
Version of Record online: 23 OCT 2013
©2013 Wiley Periodicals, Inc.
Annals of Noninvasive Electrocardiology
Volume 18, Issue 6, pages 530–537, November 2013
How to Cite
Arisha, M. M., Girerd, N., Chauveau, S., Bresson, D., Scridon, A., Bonnefoy, E. and Chevalier, P. (2013), In-Hospital Heart Rate Turbulence and Microvolt T-Wave Alternans Abnormalities for Prediction of Early Life-Threatening Ventricular Arrhythmia after Acute Myocardial Infarction. Annals of Noninvasive Electrocardiology, 18: 530–537. doi: 10.1111/anec.12072
[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”.]
- Issue online: 5 DEC 2013
- Version of Record online: 23 OCT 2013
- acute myocardial infarction;
- heart rate turbulence;
- T-wave alternans;
- sudden death
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).
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).
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).
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.