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Heart 1998;80:251-256; doi:10.1136/hrt.80.3.251
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;80:251-256 ( September )

Prognostic significance of electrical alternans versus signal averaged electrocardiography in predicting the outcome of electrophysiological testing and arrhythmia-free survival

A A Armoundas,a D S Rosenbaum,bc J N Ruskin,c H Garan,c R J Cohena

a Harvard University -Massachusetts Institute of Technology Division of Health Sciences and Technology, Cambridge, Massachusetts, USA, b Departments of Medicine and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA, c The Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to: Dr R J Cohen, Massachusetts Institute of Technology, E25-335, 77 Massachusetts Avenue, Cambridge, MA 02139, USA. email: rjcohen{at}mit.edu

Accepted for publication 30 March 1998

Objective---To investigate the accuracy of signal averaged electrocardiography (SAECG) and measurement of microvolt level T wave alternans as predictors of susceptibility to ventricular arrhythmias.
Design---Analysis of new data from a previously published prospective investigation.
Setting---Electrophysiology laboratory of a major referral hospital.
Patients and interventions---43 patients, not on class I or class III antiarrhythmic drug treatment, undergoing invasive electrophysiological testing had SAECG and T wave alternans measurements. The SAECG was considered positive in the presence of one (SAECG-I) or two (SAECG-II) of three standard criteria. T wave alternans was considered positive if the alternans ratio exceeded 3.0.
Main outcome measures---Inducibility of sustained ventricular tachycardia or fibrillation during electrophysiological testing, and 20 month arrhythmia-free survival.
Results---The accuracy of T wave alternans in predicting the outcome of electrophysiological testing was 84% (p < 0.0001). Neither SAECG-I (accuracy 60%; p < 0.29) nor SAECG-II (accuracy 71%; p < 0.10) was a statistically significant predictor of electrophysiological testing. SAECG, T wave alternans, electrophysiological testing, and follow up data were available in 36 patients while not on class I or III antiarrhythmic agents. The accuracy of T wave alternans in predicting the outcome of arrhythmia-free survival was 86% (p < 0.030). Neither SAECG-I (accuracy 65%; p < 0.21) nor SAECG-II (accuracy 71%; p < 0.48) was a statistically significant predictor of arrhythmia-free survival.
Conclusions---T wave alternans was a highly significant predictor of the outcome of electrophysiological testing and arrhythmia-free survival, while SAECG was not a statistically significant predictor. Although these results need to be confirmed in prospective clinical studies, they suggest that T wave alternans may serve as a non-invasive probe for screening high risk populations for malignant ventricular arrhythmias.

Keywords: electrophysiological testing;  electrical alternans;  signal averaged electrocardiography;  arrhythmias

© 1998 by Heart
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