Defibillator electrogram T wave alternans as a predictor of spontaneous ventricular tachyarrhythmias in defibrillator recipients

Jin Won Kim, Hui Nam Pak, Hyung Park Jae, Gi Byoung Nam, Kyoung Kim Sook, Soo Lee Hyun, Kun Jang Jin, Il Choi Jong, Young Hoon Kim

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Although T wave alternans (TWA) and the T wave peak-to-end (Tpte) interval are associated with vulnerability to ventricular tachyarrhythmia (VT), no previous reports have demonstrated that TWA immediately precedes spontaneous VT in the human ambulatory setting. Methods and Results: Stored electrograms from the implantable cardioverter defibrillators (ICD) of 74 patients (59 males, 55.3±12.2 years) were analyzed. TWA (ΔT amplitude), Tpte interval, QT interval, and RR intervals were measured from magnified digital images immediately before spontaneous VT (VTClinical; n=73), or immediately after ICD shocks during artificially-induced VT (VTInduced; n=74) or inappropriate shocks (ShockInapp; n=6). (1) TWA was significantly greater in VTClinical than VTInduced (P<0.01) or ShockInapp (P<0.001), but Tpte was not (P=NS). (2) In the VTClinical group, TWA was significantly greater in patients with ischemic VT than in those with non-ischemic cardiomyopathy or idiopathic VF (P<0.05). (3) In the same patient, the TWA for VTClinical was significantly greater than that for VTInduced (P<0.01). Conclusion: TWA measured from ICD electrograms is significantly greater immediately before spontaneous VT than immediately after inappropriate shocks or shocks during induced VT. These findings indicate that repolarization alternans plays an important role in the induction of VT in humans.

Original languageEnglish
Pages (from-to)55-62
Number of pages8
JournalCirculation Journal
Volume73
Issue number1
DOIs
Publication statusPublished - 2009 Jan 28

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Defibrillators
Tachycardia
Implantable Defibrillators
Shock
Cardiomyopathies

Keywords

  • Implantable cardioverter defibrillator
  • T wave alternans
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Defibillator electrogram T wave alternans as a predictor of spontaneous ventricular tachyarrhythmias in defibrillator recipients. / Kim, Jin Won; Pak, Hui Nam; Jae, Hyung Park; Nam, Gi Byoung; Sook, Kyoung Kim; Hyun, Soo Lee; Jin, Kun Jang; Jong, Il Choi; Kim, Young Hoon.

In: Circulation Journal, Vol. 73, No. 1, 28.01.2009, p. 55-62.

Research output: Contribution to journalArticle

Kim, Jin Won ; Pak, Hui Nam ; Jae, Hyung Park ; Nam, Gi Byoung ; Sook, Kyoung Kim ; Hyun, Soo Lee ; Jin, Kun Jang ; Jong, Il Choi ; Kim, Young Hoon. / Defibillator electrogram T wave alternans as a predictor of spontaneous ventricular tachyarrhythmias in defibrillator recipients. In: Circulation Journal. 2009 ; Vol. 73, No. 1. pp. 55-62.
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AU - Kim, Jin Won

AU - Pak, Hui Nam

AU - Jae, Hyung Park

AU - Nam, Gi Byoung

AU - Sook, Kyoung Kim

AU - Hyun, Soo Lee

AU - Jin, Kun Jang

AU - Jong, Il Choi

AU - Kim, Young Hoon

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N2 - Background: Although T wave alternans (TWA) and the T wave peak-to-end (Tpte) interval are associated with vulnerability to ventricular tachyarrhythmia (VT), no previous reports have demonstrated that TWA immediately precedes spontaneous VT in the human ambulatory setting. Methods and Results: Stored electrograms from the implantable cardioverter defibrillators (ICD) of 74 patients (59 males, 55.3±12.2 years) were analyzed. TWA (ΔT amplitude), Tpte interval, QT interval, and RR intervals were measured from magnified digital images immediately before spontaneous VT (VTClinical; n=73), or immediately after ICD shocks during artificially-induced VT (VTInduced; n=74) or inappropriate shocks (ShockInapp; n=6). (1) TWA was significantly greater in VTClinical than VTInduced (P<0.01) or ShockInapp (P<0.001), but Tpte was not (P=NS). (2) In the VTClinical group, TWA was significantly greater in patients with ischemic VT than in those with non-ischemic cardiomyopathy or idiopathic VF (P<0.05). (3) In the same patient, the TWA for VTClinical was significantly greater than that for VTInduced (P<0.01). Conclusion: TWA measured from ICD electrograms is significantly greater immediately before spontaneous VT than immediately after inappropriate shocks or shocks during induced VT. These findings indicate that repolarization alternans plays an important role in the induction of VT in humans.

AB - Background: Although T wave alternans (TWA) and the T wave peak-to-end (Tpte) interval are associated with vulnerability to ventricular tachyarrhythmia (VT), no previous reports have demonstrated that TWA immediately precedes spontaneous VT in the human ambulatory setting. Methods and Results: Stored electrograms from the implantable cardioverter defibrillators (ICD) of 74 patients (59 males, 55.3±12.2 years) were analyzed. TWA (ΔT amplitude), Tpte interval, QT interval, and RR intervals were measured from magnified digital images immediately before spontaneous VT (VTClinical; n=73), or immediately after ICD shocks during artificially-induced VT (VTInduced; n=74) or inappropriate shocks (ShockInapp; n=6). (1) TWA was significantly greater in VTClinical than VTInduced (P<0.01) or ShockInapp (P<0.001), but Tpte was not (P=NS). (2) In the VTClinical group, TWA was significantly greater in patients with ischemic VT than in those with non-ischemic cardiomyopathy or idiopathic VF (P<0.05). (3) In the same patient, the TWA for VTClinical was significantly greater than that for VTInduced (P<0.01). Conclusion: TWA measured from ICD electrograms is significantly greater immediately before spontaneous VT than immediately after inappropriate shocks or shocks during induced VT. These findings indicate that repolarization alternans plays an important role in the induction of VT in humans.

KW - Implantable cardioverter defibrillator

KW - T wave alternans

KW - Ventricular tachycardia

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