The Power of Exercise-Induced T-wave Alternans to Predict Ventricular Arrhythmias in Patients with Implanted Cardiac Defibrillator

Burattini, Laura; Man, Sumche; Sweene, Cees A.

doi:https://doi.org/10.1260/2040-2295.4.2.167

Journal of Healthcare Engineering

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Research Article | Open Access

Volume 4 | Article ID 108536 | https://doi.org/10.1260/2040-2295.4.2.167

The Power of Exercise-Induced T-wave Alternans to Predict Ventricular Arrhythmias in Patients with Implanted Cardiac Defibrillator

Laura Burattini,¹Sumche Man,²and Cees A. Sweene²

Received01 Sept 2012

Accepted01 Feb 2013

Abstract

The power of exercise-induced T-wave alternans (TWA) to predict the occurrence of ventricular arrhythmias was evaluated in 67 patients with an implanted cardiac defibrillator (ICD). During the 4-year follow-up, electrocardiographic (ECG) tracings were recorded in a bicycle ergometer test with increasing workload ranging from zero (NoWL) to the patient's maximal capacity (MaxWL). After the follow-up, patients were classified as either ICD_Cases (n = 29), if developed ventricular tachycardia/fibrillation, or ICD_Controls (n = 38). TWA was quantified using our heart-rate adaptive match filter. Compared to NoWL, MaxWL was characterized by faster heart rates and higher TWA in both ICD_Cases (12-18 μ V vs. 20-39 μ V; P < 0.05) and ICD_Controls (9-15 μ V vs. 20-32 μ V; P < 0.05). Still, TWA was able to discriminate the two ICD groups during NoWL (sensitivity = 59-83%, specificity = 53-84%) but not MaxWL (sensitivity = 55-69%, specificity = 39-74%). Thus, this retrospective observational case-control study suggests that TWA's predictive power for the occurrence of ventricular arrhythmias could increase at low heart rates.

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