Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention

PELLI, Ari, Tuomas V KENTTA, M Juhani JUNTTILA, Cynthia HUBER, Simon SCHLOGL, Markus ZABEL, Marek MALÍK, Rik WILLEMS, Marc A VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING and Heikki V HUIKURI. Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention. Journal of the American Heart Association. Hoboken: Wiley-Blackwell, 2024, vol. 13, No 11, p. 1-9. ISSN 2047-9980. Available from: https://dx.doi.org/10.1161/JAHA.123.032465.

Basic information

• Original name: Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention
• Authors: PELLI, Ari, Tuomas V KENTTA, M Juhani JUNTTILA, Cynthia HUBER, Simon SCHLOGL, Markus ZABEL, Marek MALÍK (203 Czech Republic, belonging to the institution), Rik WILLEMS, Marc A VOS, Markus HARDEN, Tim FRIEDE, Christian STICHERLING and Heikki V HUIKURI.
• Edition: Journal of the American Heart Association, Hoboken, Wiley-Blackwell, 2024, 2047-9980.

Other information

• Original language: English
• Type of outcome: Article in a journal
• Field of Study: 30201 Cardiac and Cardiovascular systems
• Country of publisher: United States of America
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Impact factor: Impact factor: 5.400 in 2022
• Organization unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1161/JAHA.123.032465
• UT WoS: 001238385200034
• Keywords in English: appropriate shock; heart failure; implantable cardioverter-defibrillator; death; T-wave alternans
• Tags: 14110211, rivok
• Tags: International impact, Reviewed

Abstract

Background New methods to identify patients who benefit from a primary prophylactic implantable cardioverter-defibrillator (ICD) are needed. T-wave alternans (TWA) has been shown to associate with arrhythmogenesis of the heart and sudden cardiac death. We hypothesized that TWA might be associated with benefit from ICD implantation in primary prevention. Methods and Results In the EU-CERT-ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter-Defibrillators) study, we prospectively enrolled 2327 candidates for primary prophylactic ICD. A 24-hour Holter monitor reading was taken from all recruited patients at enrollment. TWA was assessed from Holter monitoring using the modified moving average method. Study outcomes were all-cause death, appropriate shock, and survival benefit. TWA was assessed both as a contiguous variable and as a dichotomized variable with cutoff points <47 mu V and <60 mu V. The final cohort included 1734 valid T-wave alternans samples, 1211 patients with ICD, and 523 control patients with conservative treatment, with a mean follow-up time of 2.3 years. TWA >= 60 mu V was a predicter for a higher all-cause death in patients with an ICD on the basis of a univariate Cox regression model (hazard ratio, 1.484 [95% CI, 1.024-2.151]; P=0.0374; concordance statistic, 0.51). In multivariable models, TWA was not prognostic of death or appropriate shocks in patients with an ICD. In addition, TWA was not prognostic of death in control patients. In a propensity score-adjusted Cox regression model, TWA was not a predictor of ICD benefit. Conclusions T-wave alternans is poorly prognostic in patients with a primary prophylactic ICD. Although it may be prognostic of life-threatening arrhythmias and sudden cardiac death in several patient populations, it does not seem to be useful in assessing benefit from ICD therapy in primary prevention among patients with an ejection fraction of <= 35%.