Microvolt T-wave alternans: an effective approach to risk stratification in ischemic cardiomyopathy?
J Thomas Bigger and Daniel M Bloomfield*
Correspondence *Columbia University Medical Center, 630 West 168th Street, PH 9–103, New York, NY 10032, USA
Email twa.dcc@ctcc.cpmc.columbia.edu
This article has no abstract so we have provided the first paragraph of the full text.
Cardiac defibrillation is an effective therapy for cardiac arrest if delivered within minutes of onset. Very few patients receive external defibrillation within this narrow time frame, however, and ICD prophylaxis has, therefore, emerged as an alternative therapeutic strategy. Today, patients are selected for ICD prophylaxis primarily on the basis of LVEF (<0.30–0.40) and the presence of heart failure, but about 80% do not get an appropriate shock during 5 years of follow up.1 We need to utilize ICD prophylaxis in fewer patients who are unlikely to benefit. The best documented method to identify patients who are eligible for ICD prophylaxis, but unlikely to benefit, is MTWA testing.2, 3, 4
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