T-Wave Alternans Test and Risk for Sudden Cardiac Death

Results of the ABCD trial suggest that the noninvasive TWA test is noninferior to EPS for determining risk — but that’s not saying much.

Currently, the only clinically useful measure of patients’ risk for sudden cardiac death is LV ejection fraction (JW Cardiol Oct 1 2008). However, many individuals with low LVEFs will never have cardiac arrest, and most cardiac arrest victims have LVEFs >40%. An instrument to further refine patients’ risk is sorely needed to more accurately identify patients who will and will not benefit from an implantable cardioverter-defibrillator. Of the many tests studied during the past two decades, only the invasive electrophysiology study (EPS) has shown some accuracy for determining arrhythmic risk. However, the clinical use of this test is limited to patients with LVEFs between 35% and 40% or with syncope and LVEFs >40%.

The noninvasive T-wave alte…

Reviewing Author

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate