Is there a role of MMA T wave alternans test for risk assessment in Brugada syndrome?

Yalın, Kıvanç; Gölcük, Ebru; Teker, Erhan; Bilge, Ahmet Kaya; Adalet, Kâmil

doi:10.5152/akd.2013.228

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…However, in VF and syncope groups with Br-S, variation of TWA tended to be fewer than in asymptomatic and control groups. As previous reports [19,28] the values of max-TWA at higher heart rate may not be associated with cardiac events in patients with Br-S.…”

Section: Discussionsupporting

confidence: 53%

“…For the patients with Br-S, two studies used an MMA analysis of TWA to evaluate the predictive role of life-threatening arrhythmias. Yalin et al showed that an MMA analysis of TWA during exercise testing and recovery time could not identify high-risk patients with Br-S [19]. In the present study, we focused on the MMA analysis of TWA using 24-M-ECG, without conducting stress tests.…”

Section: Discussionmentioning

confidence: 94%

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Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

et al. 2015

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The prognostic value of T-wave alternans (TWA) during the night time in patients with Brugada syndrome (Br-S) remains unknown. We assessed TWA for risk stratification using 24-h multichannel Holter electrocardiogram (24-M-ECG) in Br-S. We enrolled 129 patients with Br-S [grouped according to histories of ventricular fibrillation (VF), n = 16; syncope, n = 10; or no symptoms (asymptomatic), n = 103] and 11 controls. Precordial electrodes were attached to the third (3L-V1, 3L-V2) and fourth (4L-V1, 4L-V2 and 4L-V5) intercostal spaces. We measured the values of maximum TWA (max-TWA) during the night time (12 a.m.-6 a.m.) and the day time (12 p.m.-6 p.m.) and calculated parameters of heart rate variability. Compared to the asymptomatic and control groups, the VF and syncope groups showed significantly greater 3L-V2 max-TWA during the night time. The cutoff value for the 3L-V2 max-TWA during the night time was determined as 20 µV (sensitivity 94 % and specificity 48 %; p = 0.01). Multivariate analysis revealed that 3L-V2 max-TWA during the night time ≥20 µV and previous VF episodes were independent predictors of future VF episodes. During a mean follow-up period of 68 ± 37 months, 16 patients experienced VF episodes. The incidence of VF episodes was the highest during the night time (p < 0.001). The 3L-V2 max-TWA during the night time may be a useful predictor for VF episodes in patients with Br-S.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 94%

Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

et al. 2015

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“…In addition, intracardiac repolarization alternans plays an important pathogenetic role in the formation of malignant arrhythmias in channelopathies. There is no previous study to show that the TWA analysis assesses the arrhythmic risk in patients with Brugada syndrome or long QT ( 13 , 14 ). In the present study, we investigated whether the MTWA could be a potential predictor of cardiac events, focusing on arrhythmic events and the predicted HCM Risk-SCD in patients with HCM.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Özyılmaz¹

2018

Anatol J Cardiol

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Objective:Micro T-wave alternans (MTWA) has been associated with poor arrhythmic prognosis in various cardiac disorders. The aim of this study was to assess the relationship between the presence of MTWA and the predicted 5-year risk of sudden cardiac death (HCM Risk-SCD) among patients with hypertrophic cardiomyopathy (HCM).Methods:A total of 117 consecutive HCM patients were included in this prospective observational study. Patients were divided into two groups, according to the presence [MTWA (+) group (n=44)] or absence [MTWA (−) group (n=73)] of MTWA on ambulatory (Holter) electrocardiography.Results:The risk of HCM Risk-SCD (%), the rate of high-risk patients (HCM Risk-ECG >6%), the requirement for cardiopulmonary resuscitation, and implanted cardioverter defibrillator therapy, the percentage of some clinical, echocardiographic, and Holter findings were all statistically higher in the MTWA (+) group than in the MTWA (−) group (all p<0.05). Both in the univariate and multivariate analyses, T-wave alternans (+) and the New York Heart Association’s functional classification assigned that the HCM Risk-SCD is an independent predictor of high risk. In the receiver operating characteristic curve analysis, the HCM Risk-SCD >4.9% was identified as an effective cutoff point in the MTWA (+) for HCM. The HCM Risk-SCD value of more than 4.9 yielded a sensitivity of 93.2% and a specificity of 84.5%.Conclusion:The presence of the MTWA on ambulatory electrocardiogram seems to be significantly associated with increasing percentages of the predicted HCM Risk-SCD score in patients with HCM. The MTWA was determined as an independent high-risk indicator for HCM Risk-SCD.

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Is there a role of MMA T wave alternans test for risk assessment in Brugada syndrome?

Verrier¹

2013

Anadolu Kardiyol Derg

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We read with interest the scientific letter by Drs. Yalin et al. (1) in The Anatolian Journal of Cardiology on the null outcome of their T-wave alternans (TWA) analysis by the Modified Moving Average method in patients with the Brugada syndrome. To date, TWA has been found in only two studies (2, 3) to predict lethal arrhythmias in Brugada syndrome patients, despite the fact that it is a prominent feature in their ambulatory ECG (AECG) recordings (4). Tada and colleagues (2) reported in a case series of 77 Brugada syndrome patients that overt TWA provoked by pilsicainide predicted spontaneous ventricular fibrillation with odds of 22.2 (95% CI: 3.3-149.9, p<0.001) after multivariate analysis. Most recently, Uchimura-Makita and coworkers (3) used MMA-based TWA in a case series of 42 Brugada syndrome patients and reported that the incidence of VF events was significantly higher among those with TWA ≥60μV than in those with lower TWA levels in lead V2 (p=0.0026).Dr. Yalin et al.(1) indicated that TWA testing was performed at the time of diagnosis of Brugada syndrome but did not state whether the patients were undergoing an exercise stress test or were at rest. While no studies have been undertaken to examine the optimum recording conditions for TWA analysis, it is reasonable to expect that TWA testing should be performed in conjunction with a diagnostic stressor such as the sodium channel blocking agents ajmaline, flecainide, procainamide, pilsicainide (2, 5), which unmask the Brugada syndrome (6), or during spontaneous appearance of the diagnostic Brugada ECG during daily activity at more normal heart rates (7), as is captured on AECG recordings. Indeed, the presence of TWA is considered to support the diagnosis of Brugada syndrome in asymptomatic patients with ST-segment elevation in at least one right precordial lead (6). Nighttime may be a particularly suitable period for AECG recording for TWA analysis, as the majority of ventricular fibrillation episodes in Brugada syndrome patients occur during sleep (8). The finding that TWA level is greatly reduced when heart rate is increased to 80-110 beats/min (7), such as is reached during exercise, may be the key to the failure of TWA testing by the spectral method (9, 10). If TWA had been analyzed from AECGs recorded during daily activity or sleep, it is likely that many if not all of the Brugada syndrome patients enrolled in this study may have shown significant levels of TWA.Determining the most appropriate setting for TWA testing in Brugada Syndrome patients will be an important contribution to stratification of their risk for lethal arrhythmias and ICD discharge.We compliment Dr. Yalin and colleagues on the valuable contributions of their study.With best regards,

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Is there a role of MMA T wave alternans test for risk assessment in Brugada syndrome?

Cited by 3 publications

References 10 publications

Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

Utility of T-wave alternans during night time as a predictor for ventricular fibrillation in patients with Brugada syndrome

Assessment of the relationship between the ambulatory electrocardiography-based micro T wave alternans and the predicted risk score of sudden cardiac death at five years in patients with hypertrophic cardiomyopathy

Is there a role of MMA T wave alternans test for risk assessment in Brugada syndrome?

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