Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction

Ikeda, Takanori; Saruta, Takao; Takami, Mitsuru; Kondo, Naoki; Tezuka, Naoki; Nakae, Takeshi; Noro, Mahito; Enjoji, Yoshihisa; Abe, Ryoji; Sugi, Kaoru; Yamaguchi, Tetsu

doi:10.1016/s0735-1097(99)00590-2

Cited by 198 publications

(132 citation statements)

References 28 publications

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“…[18][19][20][21] DAD is known to be augmented if intracellular calcium overload occurs in the presence of an abnormal ryanodine receptor. 14,[19][20][21] Altered calcium cycling is now believed to result in alteration of repolarization and T-wave alternans and T-wave alternans is established as a strong predictor of arrhythmogenic risk, [22][23][24] but such an ECG marker of repolarization has not yet been evaluated in CPVT in which abnormal calcium cycling is highly possible. [17][18][19][20][21]25) We observed macroscopic alteration in the U-wave: alternans in 2 patients and a change in the polarity after a pause among 7 patients with CPVT.…”

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confidence: 99%

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

et al. 2006

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SUMMARYAlthough catecholaminergic polymorphic ventricular tachycardia (CPVT) is associated with fatal ventricular arrhythmias and sudden death, the ECG findings are not fully understood. In this paper, we report on alterations in the U-wave.Seven patients from 6 families with CPVT in which bidirectional tachycardia and polymorphic VT were induced by exercise or isoproterenol infusion visited our hospitals. VT was not inducible by programmed electrical stimulation. A novel gene mutation of the ryanodine receptor 2 (RyR2) was confirmed in 2 families.In one of these patients, U-wave alternans was observed following ventricular pacing at 160 beats/min. In the other patient, U-wave alternans was observed during the recovery phase after the exercise stress test, which was terminated because of polymorphic VT. In both cases, leads V 3 -V 5 were the leads showing alternans most clearly. In the third patient, a negative U-wave became positive following a pause from sinus arrest and a change in T-wave was also noted.Since such findings were not found in the other subjects who underwent electrophysiologic study, isoproterenol infusion or exercise stress testing, the phenomenon seems to be relevant to the underlying pathogenesis of CPVT. The genesis and significance of Uwave alteration need to be determined. (Int Heart J 2006; 47: 381-389)

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confidence: 99%

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

et al. 2006

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“…Since late potentials detected by SA-ECG reflect conduction abnormalities, they are considered to be a predictive marker of arrhythmic events in organic heart disease (Kuchar et al 1987;Ikeda et al 2000). On the other hand, the mechanisms of developing late potentials in Brugada syndrome are considered as being based on both repolarization and depolarization abnormality theory (Antzelevitch 2002;Huang et al 2009).…”

Section: Late Potentials By Sa-ecgmentioning

confidence: 99%

“…Depolarization abnormalities noted in these studies may contribute to the development of late potentials in patients with Brugada syndrome. It was previously reported that late potentials detected by SA-ECG play some roles in risk stratification for patients with type 1 ECG, in whom especially measurement of RMS40 in late potentials is useful to predict their arrhythmic events (Kuchar et al 1987;Ikeda et al 2000;Ajiro et al 2005;Huang et al 2009). However, the risk stratification strategy for patients with type 2 ECG remains to be established (Ikeda et al 2001;Ajiro et al 2005;Huang et al 2009).…”

Section: Late Potentials By Sa-ecgmentioning

confidence: 99%

“…Late potentials on the signal-averaged ECG (SA-ECG) are known as one of the risk markers of arrhythmic events in patients with organic heart disease (Kuchar et al 1987;Ikeda et al 2000). Late potentials are also frequently seen in patients with Brugada syndrome, especially among those with type 1 ECG, and they also could be associated with their arrhythmic risk stratification (Huang et al 2009).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Significance of Late Potentials in Outpatients with Type 2 Brugada Electrocardiogram

Fukuda

Kondo

Segawa

et al. 2016

Tohoku J. Exp. Med.

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Brugada syndrome is characterized by distinguishing electrocardiogram (ECG) patterns (coved and saddleback types with day-to-day variation) and occurrence of lethal tachy-arrhythmias. The appearance of coved type ECG (type 1) is required for the diagnosis of Brugada syndrome, whereas the significance of saddleback type ECG (type 2), which is inadequate for the diagnosis, has not been fully established. We enrolled 34 consecutive patients with type 2 ECG on outpatient-clinic. Among them, 7 patients were ventricular fibrillation (VF) survivors who were diagnosed as Brugada syndrome with transient appearance of type 1 ECG, and showed type 2 ECG on their first outpatient-clinic visit after the VF event (VF group). The remaining 27 were asymptomatic and never showed type 1 ECG on repeated ECG examinations (control group). The VF group showed significantly longer RJ intervals in leads V1 and V2 and QTc intervals in lead V2 compared with the control group (P < 0.030, P < 0.017, and P < 0.030, respectively). Late potentials, detected on the signal-averaged ECG (SA-ECG), reflect conduction abnormalities and are known as one of the risk markers of arrhythmic events. Among the 34 patients, late potentials were negative in 12 patients belonging to the control group. In conclusion, the SA-ECG could be helpful to identify high-risk patients for its high negative predictive value as the first step, and ECG parameters, including RJ intervals in leads V1 and V2 and QTc interval in lead V2, could be useful for further risk stratification in patients with type 2 Brugada ECG.

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“…T o assess the risk of Sudden Cardiac Death (SCD), several electrocardiograms (ECG)-based predictors have been proposed in [1]. Among these, T-wave alternans (TWA) is one of the most promising predictors of SCD [2,3], which is defined as a beat-to-beat change in the amplitude of the T-wave that repeats once every other beat.…”

Section: Introduction Microvolt T-wave Alternansmentioning

confidence: 99%

Fractal-Dimension-Based Method for Quantification of T-Wave Alternans Using Short Time Series

Sakai¹

2013

J Comput Sci Syst Biol

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The presence of T-Wave Alternans (TWA) in an electrocardiogram (ECG) has been certified as an important predictor for the risk of sudden cardiac death (SCD). TWA is a beat-to-beat change in the amplitude of a T-wave, but is rarely visible to the naked eye. Thus, automatic detection and quantification of TWA are desirable. While several automatic algorithms, such as the periodogram method or the modified moving average method (MMA), have been developed to detect or quantify TWA, most conventional methods do not effectively measure short-duration TWA (SDTWA) (<16 beats). In this paper, we proposed a fractal dimension based SDTWA quantification method, and evaluated it with simulated ECG signals with SDTWA episodes (<16 beats) based on the European ST-T database. In the evaluation, the proposed method was applied to ECG signals with TWA amplitude of 5, 15, 30, 45, 60 and 75 μV. Sensitivity and positive predictivity of over or closed to 90% were obtained except for the 5 μV SDTWA episodes. Even for 5 μV SDTWA episodes, the sensitivity reached 75%. We believe that proposed s fractal dimension based method is a promising method for SDTWA analysis.

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Combined assessment of T-wave alternans and late potentials used to predict arrhythmic events after myocardial infarction

Abstract: The combined assessment of TWA and LP was associated with a high positive predictive value for an arrhythmic event after acute MI. Therefore, it could be a useful index to identify patients at high risk of arrhythmic events.

Cited by 198 publications

References 28 publications

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

Distinct U Wave Changes in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

Prognostic Significance of Late Potentials in Outpatients with Type 2 Brugada Electrocardiogram

Fractal-Dimension-Based Method for Quantification of T-Wave Alternans Using Short Time Series

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