Document Detail

Microvolt T-wave alternans during exercise and pacing are not comparable.
MedLine Citation:
PMID:  19758980     Owner:  NLM     Status:  MEDLINE    
AIMS: The absence of microvolt T-wave alternans (MTWA) identifies a group of patients who are at low risk for ventricular arrhythmia or sudden cardiac death. However, in exercised assessed MTWA, 20-40% of all test results are indeterminate. We hypothesised that MTWA during pacing would yield less indeterminate results. METHODS AND RESULTS: Thirty patients with ischaemic cardiomyopathy and prior dual chamber implantable cardioverter defibrillator implantation were enrolled. All patients underwent sequential MTWA testing using an exercise (E), atrial-paced (A), and atrioventricular-paced (AV) protocol. The number of indeterminate tests was lower during pacing (A: 17%; AV: 3%) compared with exercise (37%) (E vs. A: P = 0.015, E vs. AV: P = <0.001). When positive and indeterminate test results were grouped as non-negative, the concordance rates between E and A, E and AV, and A and AV were 60% (kappa = 0.17), 57% (kappa = 0.058), and 70% (kappa = 0.348), respectively. If indeterminate results were excluded, agreements were 60% (kappa = 0.19), 50% (kappa = 0.129) and 67% (kappa = 0.33), respectively. CONCLUSION: Indeterminate test results are less common during pacing. However, there is a low concordance rate between test results using different protocols. This necessitates further study to determine the predictive value of each method in high risk patients with ischaemic cardiomyopathy.
Karin Kraaier; Patrick M J Verhorst; Job van der Palen; Pascal F H M van Dessel; Arthur A M Wilde; Marcoen F Scholten
Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-09-15
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  11     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-02     Completed Date:  2010-01-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  1375-80     Citation Subset:  IM    
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER Enschede, The Netherlands.
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MeSH Terms
Cardiac Pacing, Artificial / methods*
Cardiomyopathies / complications,  diagnosis*
Electrocardiography / methods*
Exercise Test / methods*
Middle Aged
Myocardial Ischemia / complications,  diagnosis*
Reproducibility of Results
Sensitivity and Specificity
Comment In:
Europace. 2010 Jan;12(1):146; author reply 146-7   [PMID:  20008497 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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