SUDDEN DEATH RISK STRATIFICATION IN ATHLETES WITH VENTRICULAR ARRHYTHMIAS: USEFULNESS OF T-WAVE ALTERNANS.

Category:  09 Signal Average ECG/T-Wave Alternans

Presentation Time: Thursday, 2:30 p.m. - 2:45 p.m.

Giuseppe Inama, MD, Massimiliano Nanetti, MD, Claudio Pedrinazzi, MD, Ornella Durin, MD, Giorgio Donato, MD and Pietro Agricola, MD. Ospedale Maggiore, Crema, Italy

Presentation Number: AB14-5

Keyword: T-wave alternans, Death, sudden

Introduction. The usefulness of TWA in predicting the risk of ventricular tachyarrhythmias (VT) has been widely demonstrated in several clinical conditions. Aim of our study was to evaluate the role of TWA to stratify the risk of sudden cardiac death in athletes (ath) with complex VT, and to document a possible correlation between TWA and electrophysiological testing (EPT) results.
Methods. We studied 20 ath (12 M, mean age 29 years, range 13-45). All subjects were ath (4 of them classified as “elite athletes”) engaged in 5 different sports, affected by VT (> 50 premature ventricular complexes/hour or non-sustained VT). 16 patients (80%) were symptomatic for palpitation, syncope or pre-syncope. In all cases a basic cardiological evaluation was performed, including ECG, 24-hour ambulatory ECG, echo, exercise test, TWA and EPT. Coronary angiography was performed in 6 cases, and cardiac magnetic resonance in 10.
Results. TWA was negative in 15 ath (75%), positive in 2 (10%) and undetermined in 3 (15%). All subjects with negative TWA did not show induction of malignant VTs (ventricular tachycardia or ventricular fibrillation) at EPT. The 2 ath with positive TWA also had malignant VT induced by a EPT and received an implantable cardioverters defibrillator (ICD). In 2 of the 3 ath with undetermined TWA, who had a history of non-sustained VT, malignant VT were induced at EPT, but their clinical setting excluded the use of an ICD. During follow-up, the patients treated with ICD showed appropriate device interventions to terminate spontaneous VT. In all other subjects we observed no episodes of malignant VT.
Conclusion. TWA confirm its role as a simple and non-invasive test, and it seems useful for prognostic stratification of ath with VT. Similarly to the literature, TWA predictivity values are promising also in such a specific population, even if larger cohorts are required to refine such calculations. If confirmed in larger trials, combining TWA and EPT may be an useful approach to improve risk stratification of sudden cardiac death in ath with positive