Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy: A solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum

Daniel M. Bloomfield, Richard C. Steinman, Pearila B. Namerow, Michael K. Parides, Jorge Davidenko, Elizabeth S. Kaufman, Timothy Shinn, Anne Curtis, John Fontaine, Douglas Holmes, Andrea Russo, Chuen Tang, J. Thomas Bigger

Research output: Contribution to journalArticle

288 Citations (Scopus)

Abstract

Background - In 2003, the Centers for Medicaid and Medicare Services recommended QRS duration as a means to identify MADIT II-like patients suitable for implanted cardiac defibrillator (ICD) therapy. We compared the ability of microvolt T-wave alternans and QRS duration to identify groups at high and low risk of dying among heart failure patients who met MADIT II criteria for ICD prophylaxis. Methods and Results - Patients with MADIT II characteristics and sinus rhythm had a microvolt T-wave alternans exercise test and a 12-lead ECG. Our primary end point was 2-year all-cause mortality. Of 177 MADIT II-like patients, 32% had a QRS duration >120 ms, and 68% had an abnormal (positive or indeterminate) microvolt T-wave alternans test. During an average follow-up of 20±6 months, 20 patients died. We compared patients with an abnormal microvolt T-wave alternans test to those with a normal (negative) test, and patients with a QRS >120 ms with those with a QRS ≤120 ms; the hazard ratios for 2-year mortality were 4.8 (P=0.020) and 1.5 (P=0.367), respectively. The actuarial mortality rate was substantially lower among patients with a normal microvolt T-wave alternans test (3.8%; 95% confidence interval: 0, 9.0) than the mortality rate in patients with a narrow QRS (12.0%; 95% confidence interval: 5.6, 18.5). The corresponding false-negative rates are 3.5% and 10.2%, respectively. Conclusion - Among MADIT II-like patients, a microvolt T-wave alternans test is better than QRS duration at identifying a high-risk group and also better at identifying a low-risk group unlikely to benefit from ICD therapy.

Original languageEnglish (US)
Pages (from-to)1885-1889
Number of pages5
JournalCirculation
Volume110
Issue number14
DOIs
StatePublished - Oct 5 2004
Externally publishedYes

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Defibrillators
Therapeutics
Mortality
Confidence Intervals
Centers for Medicare and Medicaid Services (U.S.)
Exercise Test
Electrocardiography
Heart Failure

Keywords

  • Coronary disease
  • Death, sudden
  • Defibrillation
  • Heart arrest
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy : A solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. / Bloomfield, Daniel M.; Steinman, Richard C.; Namerow, Pearila B.; Parides, Michael K.; Davidenko, Jorge; Kaufman, Elizabeth S.; Shinn, Timothy; Curtis, Anne; Fontaine, John; Holmes, Douglas; Russo, Andrea; Tang, Chuen; Bigger, J. Thomas.

In: Circulation, Vol. 110, No. 14, 05.10.2004, p. 1885-1889.

Research output: Contribution to journalArticle

Bloomfield, Daniel M. ; Steinman, Richard C. ; Namerow, Pearila B. ; Parides, Michael K. ; Davidenko, Jorge ; Kaufman, Elizabeth S. ; Shinn, Timothy ; Curtis, Anne ; Fontaine, John ; Holmes, Douglas ; Russo, Andrea ; Tang, Chuen ; Bigger, J. Thomas. / Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy : A solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum. In: Circulation. 2004 ; Vol. 110, No. 14. pp. 1885-1889.
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abstract = "Background - In 2003, the Centers for Medicaid and Medicare Services recommended QRS duration as a means to identify MADIT II-like patients suitable for implanted cardiac defibrillator (ICD) therapy. We compared the ability of microvolt T-wave alternans and QRS duration to identify groups at high and low risk of dying among heart failure patients who met MADIT II criteria for ICD prophylaxis. Methods and Results - Patients with MADIT II characteristics and sinus rhythm had a microvolt T-wave alternans exercise test and a 12-lead ECG. Our primary end point was 2-year all-cause mortality. Of 177 MADIT II-like patients, 32{\%} had a QRS duration >120 ms, and 68{\%} had an abnormal (positive or indeterminate) microvolt T-wave alternans test. During an average follow-up of 20±6 months, 20 patients died. We compared patients with an abnormal microvolt T-wave alternans test to those with a normal (negative) test, and patients with a QRS >120 ms with those with a QRS ≤120 ms; the hazard ratios for 2-year mortality were 4.8 (P=0.020) and 1.5 (P=0.367), respectively. The actuarial mortality rate was substantially lower among patients with a normal microvolt T-wave alternans test (3.8{\%}; 95{\%} confidence interval: 0, 9.0) than the mortality rate in patients with a narrow QRS (12.0{\%}; 95{\%} confidence interval: 5.6, 18.5). The corresponding false-negative rates are 3.5{\%} and 10.2{\%}, respectively. Conclusion - Among MADIT II-like patients, a microvolt T-wave alternans test is better than QRS duration at identifying a high-risk group and also better at identifying a low-risk group unlikely to benefit from ICD therapy.",
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T1 - Microvolt T-wave alternans distinguishes between patients likely and patients not likely to benefit from implanted cardiac defibrillator therapy

T2 - A solution to the Multicenter Automatic Defibrillator Implantation Trial (MADIT) II conundrum

AU - Bloomfield, Daniel M.

AU - Steinman, Richard C.

AU - Namerow, Pearila B.

AU - Parides, Michael K.

AU - Davidenko, Jorge

AU - Kaufman, Elizabeth S.

AU - Shinn, Timothy

AU - Curtis, Anne

AU - Fontaine, John

AU - Holmes, Douglas

AU - Russo, Andrea

AU - Tang, Chuen

AU - Bigger, J. Thomas

PY - 2004/10/5

Y1 - 2004/10/5

N2 - Background - In 2003, the Centers for Medicaid and Medicare Services recommended QRS duration as a means to identify MADIT II-like patients suitable for implanted cardiac defibrillator (ICD) therapy. We compared the ability of microvolt T-wave alternans and QRS duration to identify groups at high and low risk of dying among heart failure patients who met MADIT II criteria for ICD prophylaxis. Methods and Results - Patients with MADIT II characteristics and sinus rhythm had a microvolt T-wave alternans exercise test and a 12-lead ECG. Our primary end point was 2-year all-cause mortality. Of 177 MADIT II-like patients, 32% had a QRS duration >120 ms, and 68% had an abnormal (positive or indeterminate) microvolt T-wave alternans test. During an average follow-up of 20±6 months, 20 patients died. We compared patients with an abnormal microvolt T-wave alternans test to those with a normal (negative) test, and patients with a QRS >120 ms with those with a QRS ≤120 ms; the hazard ratios for 2-year mortality were 4.8 (P=0.020) and 1.5 (P=0.367), respectively. The actuarial mortality rate was substantially lower among patients with a normal microvolt T-wave alternans test (3.8%; 95% confidence interval: 0, 9.0) than the mortality rate in patients with a narrow QRS (12.0%; 95% confidence interval: 5.6, 18.5). The corresponding false-negative rates are 3.5% and 10.2%, respectively. Conclusion - Among MADIT II-like patients, a microvolt T-wave alternans test is better than QRS duration at identifying a high-risk group and also better at identifying a low-risk group unlikely to benefit from ICD therapy.

AB - Background - In 2003, the Centers for Medicaid and Medicare Services recommended QRS duration as a means to identify MADIT II-like patients suitable for implanted cardiac defibrillator (ICD) therapy. We compared the ability of microvolt T-wave alternans and QRS duration to identify groups at high and low risk of dying among heart failure patients who met MADIT II criteria for ICD prophylaxis. Methods and Results - Patients with MADIT II characteristics and sinus rhythm had a microvolt T-wave alternans exercise test and a 12-lead ECG. Our primary end point was 2-year all-cause mortality. Of 177 MADIT II-like patients, 32% had a QRS duration >120 ms, and 68% had an abnormal (positive or indeterminate) microvolt T-wave alternans test. During an average follow-up of 20±6 months, 20 patients died. We compared patients with an abnormal microvolt T-wave alternans test to those with a normal (negative) test, and patients with a QRS >120 ms with those with a QRS ≤120 ms; the hazard ratios for 2-year mortality were 4.8 (P=0.020) and 1.5 (P=0.367), respectively. The actuarial mortality rate was substantially lower among patients with a normal microvolt T-wave alternans test (3.8%; 95% confidence interval: 0, 9.0) than the mortality rate in patients with a narrow QRS (12.0%; 95% confidence interval: 5.6, 18.5). The corresponding false-negative rates are 3.5% and 10.2%, respectively. Conclusion - Among MADIT II-like patients, a microvolt T-wave alternans test is better than QRS duration at identifying a high-risk group and also better at identifying a low-risk group unlikely to benefit from ICD therapy.

KW - Coronary disease

KW - Death, sudden

KW - Defibrillation

KW - Heart arrest

KW - Heart failure

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