Microvolt T-Wave Alternans for Risk Stratification in Athletes with Ventricular Arrhythmias: Correlation with Programmed Ventricular Stimulation

• Published in: Annals of noninvasive electrocardiology 2008-01, Vol.13 (1), p.14-21
• Main Authors: Inama, Giuseppe, Pedrinazzi, Claudio, Durin, Ornella, Nanetti, Massimiliano, Donato, Giorgio, Pizzi, Rita, Assanelli, Deodato
• Format: Article
• Language: English
• Subjects: Adult; Death, Sudden, Cardiac - etiology; Electrophysiologic Techniques, Cardiac - methods; Electrophysiologic Techniques, Cardiac - statistics & numerical data; Female; Follow-Up Studies; Humans; Male; Original; Predictive Value of Tests; Reproducibility of Results; Risk Assessment; Severity of Illness Index; sport activity; Sports - statistics & numerical data; sudden death; Survival Analysis; T-wave alternans; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; ventricular arrhythmias
• ISSN: 1082-720X; 1542-474X
• DOI: 10.1111/j.1542-474X.2007.00196.x

Background: Aim of our study is to evaluate the role of T‐wave alternans (TWA) to stratify the risk of sudden cardiac death in athletes (Ath) with complex ventricular arrhythmias (VA), and to document a possible correlation between TWA and electrophysiological testing (EPS) results. Methods: We studied 85 Ath with VA (61 M, mean age 32 ± 11 years). In all cases a cardiological evaluation was performed, including TWA and EPS. The patients were evaluated during a follow‐up of 30 ± 21 months. The end point was the occurrence of sudden death (SD) or malignant ventricular tachyarrhythmias (VT). Results: TWA was negative in 57 Ath (68%), positive in 15 (18%) and indeterminate in 13 (14%). All subjects with negative TWA did not show induction of VT at EPS, with significant correlation between negative TWA and negative EPS (P < 0.001). All Ath with positive TWA also had VT induced by a EPS, with significant correlation (P < 0.001). By contrast, our data did not show significant correlation between indeterminate TWA and positive or negative EPS. However, there was significant correlation between abnormal TWA test (positive + indeterminate) and inducibility of VT at EPS (P < 0.001). During follow‐up we observed a significant difference in end point occurrence (VT or SD) between Ath with negative or abnormal TWA and between Ath with negative or positive EPS. Conclusion: TWA confirm its role as a simple and noninvasive test, and it seems useful for prognostic stratification of Ath with VA.