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

J 2024

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 et. al.

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

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

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

Abstract

V originále

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%.

Citovat

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.

@article{2424039,
   author = {Pelli, Ari and Kentta, Tuomas V and Junttila, M Juhani and Huber, Cynthia and Schlogl, Simon and Zabel, Markus and Malík, Marek and Willems, Rik and Vos, Marc A and Harden, Markus and Friede, Tim and Sticherling, Christian and Huikuri, Heikki V},
   article_location = {Hoboken},
   article_number = {11},
   doi = {http://dx.doi.org/10.1161/JAHA.123.032465},
   keywords = {appropriate shock; heart failure; implantable cardioverter-defibrillator; death; T-wave alternans},
   language = {eng},
   issn = {2047-9980},
   journal = {Journal of the American Heart Association},
   title = {Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention},
   url = {https://www.ahajournals.org/doi/10.1161/JAHA.123.032465},
   volume = {13},
   year = {2024}
}

TY  - JOUR
ID  - 2424039
AU  - Pelli, Ari - Kentta, Tuomas V - Junttila, M Juhani - Huber, Cynthia - Schlogl, Simon - Zabel, Markus - Malík, Marek - Willems, Rik - Vos, Marc A - Harden, Markus - Friede, Tim - Sticherling, Christian - Huikuri, Heikki V
PY  - 2024
TI  - Lack of Prognostic Value of T-Wave Alternans for Implantable Cardioverter-Defibrillator Benefit in Primary Prevention
JF  - Journal of the American Heart Association
VL  - 13
IS  - 11
SP  - 1-9
EP  - 1-9
PB  - Wiley-Blackwell
SN  - 20479980
KW  - appropriate shock
KW  - heart failure
KW  - implantable cardioverter-defibrillator
KW  - death
KW  - T-wave alternans
UR  - https://www.ahajournals.org/doi/10.1161/JAHA.123.032465
N2  - 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%.
ER  -

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. \textit{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.

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