Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial

Theodore Chow; Dean J. Kereiakes; John Onufer; Alan Woelfel; Sinan Gursoy; Brett J. Peterson; Mark L. Brown; Wenji Pu; David G. Benditt

doi:10.1016/j.jacc.2008.08.018

Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial

Theodore Chow, Dean J. Kereiakes, John Onufer, Alan Woelfel, Sinan Gursoy, Brett J. Peterson, Mark L. Brown, Wenji Pu, David G. Benditt

Medicine - Cardiology Division

Research output: Contribution to journal › Article › peer-review

184 Scopus citations

Abstract

Objectives: The purpose of this trial was to determine whether microvolt T-wave alternans (MTWA) predicts ventricular tachyarrhythmic events (VTEs) in post-myocardial infarction patients with left ventricular ejection fraction (LVEF) ≤30%. Background: Previous studies have established MTWA as a predictor for total and arrhythmic mortality, but its ability to identify prophylactic implantable cardioverter-defibrillator (ICD) recipients most likely to experience VTEs remains uncertain. Methods: This prospective trial was conducted at 50 U.S. centers. Patients were eligible if they met MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) indications for device implant. All patients underwent MTWA testing followed by ICD implantation, with pre-specified programming to minimize the likelihood of therapies for non-life-threatening VTE. Minimum follow-up was 2 years with annual MTWA testing. Initially indeterminate MTWA tests were repeated. Results: Analyses were conducted on 575 patients (84% male; average age ± SD = 65 ± 11 years; average LVEF ± SD = 0.24 ± 0.05). The final distribution of MTWA results were: MTWA positive in 293 (51%), MTWA negative in 214 (37%), and indeterminate in 68 patients (12%). Over an average follow-up of 2.1 ± 0.9 years, there were 70 VTEs. A VTE occurred in 48 of 361 (13%, 6.3%/year) MTWA non-negative and 22 of 214 (10%, 5.0%/year) MTWA negative patients. A non-negative MTWA test result was not associated with VTE (hazard ratio: 1.26; 95% confidence interval: 0.76 to 2.09; p = 0.37), although total mortality was significantly increased (hazard ratio: 2.04; 95% confidence interval: 1.10 to 3.78; p = 0.02). Conclusions: In MADIT-II-indicated ICD-treated patients, the risk of VTE does not differ according to MTWA classification, despite differences in total mortality. (MASTER I-Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients; NCT00305240).

Original language	English (US)
Pages (from-to)	1607-1615
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	52
Issue number	20
DOIs	https://doi.org/10.1016/j.jacc.2008.08.018
State	Published - Nov 11 2008

Bibliographical note

Funding Information:
This study was sponsored by Medtronic, Inc. Dr. Chow has received honoraria from Biotronik, Cambridge Heart, Medtronic, Inc., and St. Jude Medical, and has ownership interest in Medtronic, Inc. Dr. Onufer has received honoraria from St. Jude Medical. Mr. Peterson is employed by Medtronic, Inc. Dr. Brown has ownership interest in and is employed by Medtronic, Inc. Dr. Pu has ownership interest in and is employed by Medtronic, Inc. Dr. Benditt has ownership interest in, has received honoraria from, and is on the consultant/advisory board for Medtronic, Inc. and St. Jude Medical.

Keywords

T-wave alternans
defibrillator therapy
risk stratification
sudden death
ventricular arrhythmias

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10.1016/j.jacc.2008.08.018

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Chow, T., Kereiakes, D. J., Onufer, J., Woelfel, A., Gursoy, S., Peterson, B. J., Brown, M. L., Pu, W., & Benditt, D. G. (2008). Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial. Journal of the American College of Cardiology, 52(20), 1607-1615. https://doi.org/10.1016/j.jacc.2008.08.018

Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial. / Chow, Theodore; Kereiakes, Dean J.; Onufer, John et al.
In: Journal of the American College of Cardiology, Vol. 52, No. 20, 11.11.2008, p. 1607-1615.

Research output: Contribution to journal › Article › peer-review

Chow, T, Kereiakes, DJ, Onufer, J, Woelfel, A, Gursoy, S, Peterson, BJ, Brown, ML, Pu, W & Benditt, DG 2008, 'Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial', Journal of the American College of Cardiology, vol. 52, no. 20, pp. 1607-1615. https://doi.org/10.1016/j.jacc.2008.08.018

Chow T, Kereiakes DJ, Onufer J, Woelfel A, Gursoy S, Peterson BJ et al. Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial. Journal of the American College of Cardiology. 2008 Nov 11;52(20):1607-1615. doi: 10.1016/j.jacc.2008.08.018

Chow, Theodore ; Kereiakes, Dean J. ; Onufer, John et al. / Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial. In: Journal of the American College of Cardiology. 2008 ; Vol. 52, No. 20. pp. 1607-1615.

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title = "Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial",

abstract = "Objectives: The purpose of this trial was to determine whether microvolt T-wave alternans (MTWA) predicts ventricular tachyarrhythmic events (VTEs) in post-myocardial infarction patients with left ventricular ejection fraction (LVEF) ≤30%. Background: Previous studies have established MTWA as a predictor for total and arrhythmic mortality, but its ability to identify prophylactic implantable cardioverter-defibrillator (ICD) recipients most likely to experience VTEs remains uncertain. Methods: This prospective trial was conducted at 50 U.S. centers. Patients were eligible if they met MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) indications for device implant. All patients underwent MTWA testing followed by ICD implantation, with pre-specified programming to minimize the likelihood of therapies for non-life-threatening VTE. Minimum follow-up was 2 years with annual MTWA testing. Initially indeterminate MTWA tests were repeated. Results: Analyses were conducted on 575 patients (84% male; average age ± SD = 65 ± 11 years; average LVEF ± SD = 0.24 ± 0.05). The final distribution of MTWA results were: MTWA positive in 293 (51%), MTWA negative in 214 (37%), and indeterminate in 68 patients (12%). Over an average follow-up of 2.1 ± 0.9 years, there were 70 VTEs. A VTE occurred in 48 of 361 (13%, 6.3%/year) MTWA non-negative and 22 of 214 (10%, 5.0%/year) MTWA negative patients. A non-negative MTWA test result was not associated with VTE (hazard ratio: 1.26; 95% confidence interval: 0.76 to 2.09; p = 0.37), although total mortality was significantly increased (hazard ratio: 2.04; 95% confidence interval: 1.10 to 3.78; p = 0.02). Conclusions: In MADIT-II-indicated ICD-treated patients, the risk of VTE does not differ according to MTWA classification, despite differences in total mortality. (MASTER I-Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients; NCT00305240).",

keywords = "T-wave alternans, defibrillator therapy, risk stratification, sudden death, ventricular arrhythmias",

author = "Theodore Chow and Kereiakes, {Dean J.} and John Onufer and Alan Woelfel and Sinan Gursoy and Peterson, {Brett J.} and Brown, {Mark L.} and Wenji Pu and Benditt, {David G.}",

note = "Funding Information: This study was sponsored by Medtronic, Inc. Dr. Chow has received honoraria from Biotronik, Cambridge Heart, Medtronic, Inc., and St. Jude Medical, and has ownership interest in Medtronic, Inc. Dr. Onufer has received honoraria from St. Jude Medical. Mr. Peterson is employed by Medtronic, Inc. Dr. Brown has ownership interest in and is employed by Medtronic, Inc. Dr. Pu has ownership interest in and is employed by Medtronic, Inc. Dr. Benditt has ownership interest in, has received honoraria from, and is on the consultant/advisory board for Medtronic, Inc. and St. Jude Medical. ",

year = "2008",

month = nov,

day = "11",

doi = "10.1016/j.jacc.2008.08.018",

language = "English (US)",

volume = "52",

pages = "1607--1615",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial

AU - Chow, Theodore

AU - Kereiakes, Dean J.

AU - Onufer, John

AU - Woelfel, Alan

AU - Gursoy, Sinan

AU - Peterson, Brett J.

AU - Brown, Mark L.

AU - Pu, Wenji

AU - Benditt, David G.

N1 - Funding Information: This study was sponsored by Medtronic, Inc. Dr. Chow has received honoraria from Biotronik, Cambridge Heart, Medtronic, Inc., and St. Jude Medical, and has ownership interest in Medtronic, Inc. Dr. Onufer has received honoraria from St. Jude Medical. Mr. Peterson is employed by Medtronic, Inc. Dr. Brown has ownership interest in and is employed by Medtronic, Inc. Dr. Pu has ownership interest in and is employed by Medtronic, Inc. Dr. Benditt has ownership interest in, has received honoraria from, and is on the consultant/advisory board for Medtronic, Inc. and St. Jude Medical.

PY - 2008/11/11

Y1 - 2008/11/11

N2 - Objectives: The purpose of this trial was to determine whether microvolt T-wave alternans (MTWA) predicts ventricular tachyarrhythmic events (VTEs) in post-myocardial infarction patients with left ventricular ejection fraction (LVEF) ≤30%. Background: Previous studies have established MTWA as a predictor for total and arrhythmic mortality, but its ability to identify prophylactic implantable cardioverter-defibrillator (ICD) recipients most likely to experience VTEs remains uncertain. Methods: This prospective trial was conducted at 50 U.S. centers. Patients were eligible if they met MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) indications for device implant. All patients underwent MTWA testing followed by ICD implantation, with pre-specified programming to minimize the likelihood of therapies for non-life-threatening VTE. Minimum follow-up was 2 years with annual MTWA testing. Initially indeterminate MTWA tests were repeated. Results: Analyses were conducted on 575 patients (84% male; average age ± SD = 65 ± 11 years; average LVEF ± SD = 0.24 ± 0.05). The final distribution of MTWA results were: MTWA positive in 293 (51%), MTWA negative in 214 (37%), and indeterminate in 68 patients (12%). Over an average follow-up of 2.1 ± 0.9 years, there were 70 VTEs. A VTE occurred in 48 of 361 (13%, 6.3%/year) MTWA non-negative and 22 of 214 (10%, 5.0%/year) MTWA negative patients. A non-negative MTWA test result was not associated with VTE (hazard ratio: 1.26; 95% confidence interval: 0.76 to 2.09; p = 0.37), although total mortality was significantly increased (hazard ratio: 2.04; 95% confidence interval: 1.10 to 3.78; p = 0.02). Conclusions: In MADIT-II-indicated ICD-treated patients, the risk of VTE does not differ according to MTWA classification, despite differences in total mortality. (MASTER I-Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients; NCT00305240).

AB - Objectives: The purpose of this trial was to determine whether microvolt T-wave alternans (MTWA) predicts ventricular tachyarrhythmic events (VTEs) in post-myocardial infarction patients with left ventricular ejection fraction (LVEF) ≤30%. Background: Previous studies have established MTWA as a predictor for total and arrhythmic mortality, but its ability to identify prophylactic implantable cardioverter-defibrillator (ICD) recipients most likely to experience VTEs remains uncertain. Methods: This prospective trial was conducted at 50 U.S. centers. Patients were eligible if they met MADIT-II (Multicenter Automatic Defibrillator Implantation Trial II) indications for device implant. All patients underwent MTWA testing followed by ICD implantation, with pre-specified programming to minimize the likelihood of therapies for non-life-threatening VTE. Minimum follow-up was 2 years with annual MTWA testing. Initially indeterminate MTWA tests were repeated. Results: Analyses were conducted on 575 patients (84% male; average age ± SD = 65 ± 11 years; average LVEF ± SD = 0.24 ± 0.05). The final distribution of MTWA results were: MTWA positive in 293 (51%), MTWA negative in 214 (37%), and indeterminate in 68 patients (12%). Over an average follow-up of 2.1 ± 0.9 years, there were 70 VTEs. A VTE occurred in 48 of 361 (13%, 6.3%/year) MTWA non-negative and 22 of 214 (10%, 5.0%/year) MTWA negative patients. A non-negative MTWA test result was not associated with VTE (hazard ratio: 1.26; 95% confidence interval: 0.76 to 2.09; p = 0.37), although total mortality was significantly increased (hazard ratio: 2.04; 95% confidence interval: 1.10 to 3.78; p = 0.02). Conclusions: In MADIT-II-indicated ICD-treated patients, the risk of VTE does not differ according to MTWA classification, despite differences in total mortality. (MASTER I-Microvolt T Wave Alternans Testing for Risk Stratification of Post MI Patients; NCT00305240).

KW - T-wave alternans

KW - defibrillator therapy

KW - risk stratification

KW - sudden death

KW - ventricular arrhythmias

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Does Microvolt T-Wave Alternans Testing Predict Ventricular Tachyarrhythmias in Patients With Ischemic Cardiomyopathy and Prophylactic Defibrillators?. The MASTER (Microvolt T Wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) Trial

Abstract

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Keywords

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