Can microvolt T-wave alternans predict mortality in patients with ischemic cardiomyopathy?

Stefan H Hohnloser

This article has no abstract so we have provided the first paragraph of the full text.

Sudden cardiac death (SCD) is most often due to ventricular tachyarrhythmias and remains a major challenge in contemporary cardiology. The ICD is the most effective therapy for preventing SCD in survivors of a previous out-of-hospital cardiac arrest (secondary prevention) and in patients deemed to be at high risk for SCD but without previous sustained ventricular tachyarrhythmias (primary prevention). A number of randomized primary prevention trials such as the MADIT-II,¹ SCD-HeFT,² and DEFINITE trials³ have shown that ICDs reduce total mortality by preventing arrhythmia-related SCD in patients with ischemic or nonischemic cardiomyopathy. The absolute benefit of ICD prophylaxis on mortality, however, is relatively small in patients selected exclusively or predominantly using LVEF; the majority of patients enrolled in the above trials did not use their ICD during follow-up. Furthermore, widespread ICD therapy is constrained by fixed health-care budgets and is associated with notable complications. Better identification of the patients who are most likely to benefit from device therapy is, therefore, needed.

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