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Europace Advance Access originally published online on September 15, 2009
Europace 2009 11(10):1375-1380; doi:10.1093/europace/eup253
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

T Wave Alternans

Microvolt T-wave alternans during exercise and pacing are not comparable

Karin Kraaier1, Patrick M.J. Verhorst1, Job van der Palen2, Pascal F.H.M. van Dessel1, Arthur A.M. Wilde3 and Marcoen F. Scholten1,*

1 Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands; 2 Department of Epidemiology, Medisch Spectrum Twente, Enschede, The Netherlands; 3 Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Aims: The absence of microvolt T-wave alternans (MTWA) identifies a group of patients who are at low risk for ventricular arrhythmia or sudden cardiac death. However, in exercised assessed MTWA, 20–40% of all test results are indeterminate. We hypothesised that MTWA during pacing would yield less indeterminate results.

Methods and results: Thirty patients with ischaemic cardiomyopathy and prior dual chamber implantable cardioverter defibrillator implantation were enrolled. All patients underwent sequential MTWA testing using an exercise (E), atrial-paced (A), and atrioventricular-paced (AV) protocol. The number of indeterminate tests was lower during pacing (A: 17%; AV: 3%) compared with exercise (37%) (E vs. A: P = 0.015, E vs. AV: P = <0.001). When positive and indeterminate test results were grouped as non-negative, the concordance rates between E and A, E and AV, and A and AV were 60% ({kappa} = 0.17), 57% ({kappa} = 0.058), and 70% ({kappa} = 0.348), respectively. If indeterminate results were excluded, agreements were 60% ({kappa} = 0.19), 50% ({kappa} = 0.129) and 67% ({kappa} = 0.33), respectively.

Conclusion: Indeterminate test results are less common during pacing. However, there is a low concordance rate between test results using different protocols. This necessitates further study to determine the predictive value of each method in high risk patients with ischaemic cardiomyopathy.

Key Words: Risk stratification, Sudden cardiac death, T-wave alternans, Ischaemic cardiomyopathy, Implantable cardioverter defibrillator

* Corresponding author. Tel: +31 53 487 2110, Fax: +31 53 487 2152, Email: marcoen.scholten{at}mst.nl

Manuscript submitted 16 March 2009. Accepted after revision 12 August 2009.


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