Serial electrocardiographic changes after transcatheter closure of atrial septal defects

• Published in: Journal of electrocardiology 2018-11, Vol.51 (6), p.1176-1177
• Main Authors: Kang, Minjeong, Sakamoto, Ichiro, Sawatari, Hiroyuki, Kouho, Tomoaki, Yamasaki, Keiko, Umemoto, Shintaro, Abe, Kohtaro, Hiasa, Kenichi, Ide, Tomomi, Nishizaka, Mari, Yamamura, Kenichiro, Kodama, Yoshihiko, Ishikawa, Shiro, Shinbara, Ryoji, Chishaki, Hiroaki, Tsutsui, Hiroyuki, Chishaki, Akiko
• Format: Article
• Language: English
• Subjects: Disease prevention; Electrocardiography; Medical treatment; Transplants & implants
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2018.10.055

Introduction: Prevention of sudden cardiac death (SCD) remains one of the most important issues of modern cardiology. The aim of the study was to assess prognostic value of microvolt T wave alternans (TWA MMA) in predicting outcome in patients qualified for ICD implantation. Methods: The study included consecutive sinus rhythm patients qualified for de novo ICD implantation for primary or secondary prevention. 48-hour Holter monitoring (GE Getemed CardioDay®) was performed at enrollment to assess arrhythmia and TWA MMA. Patients were followed up for 5 years. Primary endpoints were defined as: death, appropriate shocks and composite endpoint: death or appropriate shock. Results: Holter recordings were analysed in 75 patients (av. age 63±11, 16 women) at preimplantation period (62 primary and 13 secondary prevention, mean LVEF 30±12%). Mean TWA value was 60±26 \N (median 57 pV). Studied population included 56 pts with TWA>47^V and 33 pts with >60|iV. During 5 year FU 27 patients died (including 23 from primary and 4 from secondary prevention group), 11 patients had appropriate shocks (6 and 5 for primary and secondary prevention respectively). We did not observe statistically significant differences in TWA MMA between those who survived and died (61 ±30 vs 58±18 jjV, p=0.93) as well as between those who experienced or not appropriate ICD shocks (57±14 vs 60±28 pV, p= 0.85). Prespecified high risk cut offs for TWA-MMA did not predict neither death nor arrhythmic event during follow up (HR=1.69, CI=-0.14-0.66, p=0.20 and HR=1.32, CI=-0.47-0.75, p=0.65 for deaths and arrhythmic events, respectively (Fig 1). No differences in prognostic value were observed between patients implanted in primary vs. secondary prevention. Conclusions: Increased microvolt T wave alternans based on preim-plantation Holter recordings was not associated with unfavourable outcome in patients with ICDs.