Skip to main content
Annals of Noninvasive Electrocardiology logoLink to Annals of Noninvasive Electrocardiology
. 2006 Oct 27;6(4):323–332. doi: 10.1111/j.1542-474X.2001.tb00126.x

T‐Wave Alternans and Arrhythmia Risk Stratification

Nabil El‐Sherif 1,, Gioia Turitto 1, Ronald P Pedalino 1, Dyonissios Robotis 1
PMCID: PMC7027599  PMID: 11686914

The content is available as a PDF (952.3 KB).

REFERENCES

  • 1. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: Epidemiology, transient risk, and intervention assessment. Ann Intern Med 1993;119:1187–1197. [DOI] [PubMed] [Google Scholar]
  • 2. Moss AJ, Hall WJ, Cannom DS, et al. for the Multicenter Automatic Defibrillator Implantation Trial Investigators. Improved survival with an implanted defibrillator in patients with coronary artery disease at high risk for ventricular arrhythmias. N Engl J Med 1996;335: 1933–1940. [DOI] [PubMed] [Google Scholar]
  • 3. The Antiarrhythmics Versus Implantable Defibrillator (AVID) Investigators. A comparison of antiarrhythmic‐drug therapy with implantable defibrillators in patients resuscitated from near‐fatal ventricular arrhythmias. N Engl J Med 1997;337:1576–1583. [DOI] [PubMed] [Google Scholar]
  • 4. El‐Sherif N, Turitto G. In search of the optimal algorithm for risk stratification of sudden cardiac death in the era of prophylactic ICD. MESPE 1999;1:65–70. [Google Scholar]
  • 5. Bigger JT, for the Coronary Artery Bypass Graft (CABG) Patch Trial Investigators. Prophylactic use of implanted cardiac defibrillators in patients at high risk for ventricular arrhythmias after coronary‐artery bypass graft surgery. N Engl J Med 1997;337: 1569–1573. [DOI] [PubMed] [Google Scholar]
  • 6. Schmidt G, Schneider R, Barthel P. Heart rate turbulence. Card Electrophysio Rev 1999;3:297–301. [Google Scholar]
  • 7. Smith JM, Clancy EA, Vereri CR, et al. Electrical alternans and clinical electrical instability. Circulation 1988;77:110–121. [DOI] [PubMed] [Google Scholar]
  • 8. Habbab MA, El‐Sherif N. TU alternans, long QTU, and torsade de pointes: Clinical and experimental observations. PACE 1992;15:916–931. [DOI] [PubMed] [Google Scholar]
  • 9. El‐Sherif N. T‐wave Alternans: A Marker of Vulnerability to Ventricular Tachyarrhythmias Chapter In Raviele A. (ed): Cardiac Arrhythmias. Milan , Springer, 1995, pp. 12–16. [Google Scholar]
  • 10. Saitoh H, Bailey JC, Surawicz B. Action potential duration alternans in dog Purkinje and ventricular muscle fibers. Further evidence in support of two different mechanisms. Circulation 1989;80: 1421–1431. [DOI] [PubMed] [Google Scholar]
  • 11. Hauswirth O, Noble D, Tsien RW. The dependence of plateau currents in cardiac Purkinje fibers on the interval between action potentials. J Physiol (Lond) 1972;222:27–49. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Boyett MR, Jewell BR. A study of the factors responsible for rate‐dependent shortening of the action potential in mammalian ventricular muscle. J Physiol (Lond) 1978;285:359–380. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. Han J, Moe GK. Nonuniform recovery of excitability in ventricular muscle. Circ Res 1964;14:44–60. [DOI] [PubMed] [Google Scholar]
  • 14. Chinushi M, Restivo M, Caref EB, El‐Sherif N. Electrophysiological basis of the arrhythmogenicity of QT/T alternans in the long QT syndrome. Tridimensional analysis of the kinetics of cardiac repolarization. Circ Res 1998;83: 614–628. [DOI] [PubMed] [Google Scholar]
  • 15. Shimizu W, Antzelevitch C. Cellular and ionic basis for T‐wave alternans under long QT conditions. Circulation 1999;99:1499–1507. [DOI] [PubMed] [Google Scholar]
  • 16. Pastore JM, Girouard SD, Laurita KR, et al. Mechanism linking T‐wave alternans to the genesis of cardiac fibrillation. Circulation 1999;99:1385–1394. [DOI] [PubMed] [Google Scholar]
  • 17. Rosenbaum D, Albrecht P, Cohen RJ. Predicting sudden cardiac death from T‐wave alternans of the surface electrocardiogram. Promise and pitfalls. J Cardiovasc Electrophysiol 1996;7: 1095–1111. [DOI] [PubMed] [Google Scholar]
  • 18. Rosenbaum D, Jackson LE, Smith JM, et al. Electrical alternans and vulnerability to ventricular arrhythmias. H Engl J Med 1994: 330:235–241. [DOI] [PubMed] [Google Scholar]
  • 19. Nearing BD, Huang AH, Verrier RL. Dynamic tracking of cardiac vulnerability by complex demodulation of the T wave. Science 1991;252:437–440. [DOI] [PubMed] [Google Scholar]
  • 20. Verrier RL, Nearing BD. Electrophysiologic basis for T‐wave alternans as an index of vulnerability to ventricular fibrillation. J Cardiovasc Electrophysiol 1994;5:445–461. [DOI] [PubMed] [Google Scholar]
  • 21. Hohnloser SH, Klingenheben T, Zabel M, et al. T wave alternans during exercise and atrial pacing in humans. J Cardiovasc Electrophysiol 1997;8:987–993. [DOI] [PubMed] [Google Scholar]
  • 22. Verrier RL, Stone PH. Exercise stress testing for T‐wave alternans to expose latent electrical instability. J Cardiovasc Electrophysiol 1997;8:994–996. [DOI] [PubMed] [Google Scholar]
  • 23. Turitto G, Caref EB, El‐Attar G, et al. Optimal target heart rate for exercise‐induced T‐wave alternans. Ann Noninvas Electrocardiol 2001; 6:123–128. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Estes NAM III, Michaud G, Zipes DP, et al. Electrical alternans during rest and exercise as predictors of vulnerability to ventricular arrhythmias. Am J Cardiol 1997;80: 1314–1318. [DOI] [PubMed] [Google Scholar]
  • 25. Kavesh NG, Shorofsky SR, Sarang SE, et al. Effect of heart rate on T wave alternans. J Cardiovasc Electrophysiol 1998;9:703–708. [DOI] [PubMed] [Google Scholar]
  • 26. Gold MR, Bloomfield DM, Anderson KP, et al. A comparison of T‐wave alternans, signal averaged electrocardiography and programmed ventricular stimulation for arrhythmia risk stratification. J Am Coll Cardiol 2000;36:2248–2253. [DOI] [PubMed] [Google Scholar]
  • 27. Hohnloser SH, Klingenheben T, Li YG, et al. T wave alternans as a predictor of recurrent ventricular tachyarrhythmias in ICD recipients. J Cardiovasc Electrophysiol 1998;9: 1258–1268. [DOI] [PubMed] [Google Scholar]
  • 28. Murda'h M, McKenna W, Camm J. Repolarization alternans: Techniques, mechanisms, and cardiac vulnerability. PACE 1997;20(Part II):2641–2657. [DOI] [PubMed] [Google Scholar]
  • 29. Adachi K, Ohnishi Y, Shima T, et al. Determinants of microvolt‐level T wave alternans in patients with dilated cardiomyopathy. J Am Coll Cardiol 1999;34:374–380. [DOI] [PubMed] [Google Scholar]
  • 30. Hennersdorf MG, Perings C, Niebeh V, et al. T wave alternans as a risk predictor in patients with cardiomyopathy and mild‐to‐moderate heart failure. PACE 2000;23:1386–1391. [DOI] [PubMed] [Google Scholar]
  • 31. El‐Sherif N, Turitto G. The Need for Powerful Risk Stratification of Sudden Cardiac Death in the Era of Prophylactic ICD Chapter In Ovsyschcher IE. (ed): Cardiac Arrhythmias and Devise Therapy: Results and Perspective for the New Century. Armonk , NY , Futura Publishing, Armonk , NY 2000, pp. 273–284. [Google Scholar]
  • 32. Goldman S, Johnson G, Cohn JN, et al. Mechanisms of death in heart failure. The vasodilator‐heart failure trials. The V‐HeFT VA Cooperative Studies Group. Circulation 1993;87:V124–131. [PubMed] [Google Scholar]
  • 33. Klingenheben T, Zabel M, D'Agostino RB, et al. Predictive value of T‐wave alternans for arrhythmic events in patients with congestive heart failure. Lancet 2000;356:651–652. [DOI] [PubMed] [Google Scholar]
  • 34. Armoundas AA, Rosenbaum DS, Ruskin JN, et al. Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiologic testing and arrhythmia free survival. Heart 1998;80:251–256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. Ikeda T, Sakata T, Takami M, et al. Combined assessment of T‐wave alternans and late potentials used to predict arrhythmic events after myocardial infarction. J Am Coll Cardiol 2000;35:722–730. [DOI] [PubMed] [Google Scholar]
  • 36. Vazquez R., Caref EB, Torres F, et al. Improved diagnostic value of the combined time‐ and frequency‐domain analysis of the signal‐averaged electrocardiogram after myocardial infarction. J Am Coll Cardiol 1999;33:385–394. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Noninvasive Electrocardiology are provided here courtesy of International Society for Holter and Noninvasive Electrocardiology, Inc. and Wiley Periodicals, Inc.

RESOURCES