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Decreased microvolt T-wave alternation as an index for effectiveness of resynchronization therapy in patients with CHF

Vaykhanskaya T. G., Koptyukh T. M., Kurushko T. V., Sidorenko I. V., Ryabov A. A.
State Institution Republican Science and Practice Center "Cardiology", R. Luxemburg 110, Minsk, Republic of Belarus

Keywords: cardiac resynchronization therapy, dilated cardiomyopathy, microvolt T-wave alteration, ventricular tachyarrhythmias

DOI: 10.18087/rhfj.2015.4.2100

Background. Cardiac resynchronization therapy (CRT) using biventricular stimulation is an effective treatment for patients with cardiac systolic dysfunction and electromechanical ventricular asynchrony. Aim. To study the effect of reverse LV remodeling on the time course of microvolt T-wave alternation (mTWA) and ventricular tachyarrhythmic ectopic activity in patients with CRT for HF induced by dilated cardiomyopathy (DCMP). Materials and methods. The study included 69 patients with DCMP (males, 75.4 %; 48.7±11.4; NYHA FC, 3.03±0.29; sinus rhythm; complete left bundle branch block with QRS duration of 144±23.3 msec; LV EF, 27.2±7.5 %) with implanted CRT-D (n=37) and CRT-P (n=32). Multimodal examination (EchoCG, ECG HM, and 7‑min ECG using the “Intecard-7” software for analysis of ventricular ectopic beats and mTWA) was performed for all patients prior to the device implantation and after 12.9±1.3 months of follow-up. MTWA was evaluated in CRT patients at the native ventricular conduction (VVI-40 or 0V0 mode). Serial 24‑h ECG monitoring and dynamic telemetry of implanted devices were performed for detection of ventricular tachyarrhythmic (VTA) events. Results. In the general group (49 / 71 % of patients with positive clinical and hemodynamic response to CRT and 20 / 29 % of CRT non-responders), mTWA was decreased (from 53.2±14.9 to 36.6±15.7 mcV; p<0.001) 12 months after the CRT implantation. In patients with positive (reverse) LV remodeling, mTWA significantly decreased (from 51.3±13.4 to 20.6±6.32 mcV; р<0.0001), VTA episodes were absent, and changes in mTWA significantly positively correlated with the decrease in LV cavity (for ESV, r=0.52, р<0.005; for EDV, r=0.51, р<0.005) and negatively correlated with changes in LV EF (r= –0.56, р<0.005). Multifactorial and ROC analyses showed a high predictive value of the 21 mcV decrease in mTWA (∆mTWA ≥21 mcV: sensitivity, 79 %; specificity, 75 %; S=0.826; CI, 95 %: 0.749–0.902; р<0.001) as an independent predictor for low risk of VTA episodes in patients with DCMP and as an anti-arrhythmic marker for effective CRT. Conclusion. In patients with DCMP after 12 months of CRT, decreased mTWA was associated with reverse LV remodeling and low arrhythmogenic risk. The decrease in mTWA by >21 mcV can be rationally used as a non-invasive anti-arrhythmic predictor and a marker for prevention of VTA in effective CRT.
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Vaykhanskaya T. G., Koptyukh T. M., Kurushko T. V., Sidorenko I. V., Ryabov A. A. Decreased microvolt T-wave alternation as an index for effectiveness of resynchronization therapy in patients with CHF. Russian Heart Failure Journal. 2015;16 (4):195–203

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