Prognostic value of average T-wave alternans and QT variability for cardiac events in MADIT-II patients

Violeta Monasterio*, Juan Pablo Martínez, Pablo Laguna, Scott McNitt, Slava Polonsky, Arthur J. Moss, Mark Haigney, Wojciech Zareba, Jean Philippe Couderc

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background Identifying which patients might benefit the most from ICD therapy remains challenging. We hypothesize that increased T-wave alternans (TWA) and QT variability (QTV) provide complementary information for predicting appropriate ICD therapy in patients with previous myocardial infarction and reduced ejection fraction. Methods We analyzed 10-min resting ECGs from MADIT-II patients with baseline heart rate > 80 beats/min. TWA indices IAA and IAA90 were computed with the multilead Laplacian Likelihood ratio method. QTV indices QTVN and QTVI were measured using a standard approach. Cox proportional hazard models were adjusted considering appropriate ICD therapy and sudden cardiac death (SCD) as endpoints. Results TWA and QTV were measured in 175 patients. Neither QTV nor TWA predicted SCD. Appropriate ICD therapy was predicted by combining IAA90 and QTVN after adjusting for relevant correlates. Conclusion Increased TWA and QTV are independent predictors of appropriate ICD therapy in MADIT-II patients with elevated heart rate at baseline.

Original languageEnglish
Pages (from-to)480-486
Number of pages7
JournalJournal of Electrocardiology
Issue number6
StatePublished - Nov 2013
Externally publishedYes


  • Holter ECG
  • ICD therapy
  • Sudden cardiac death
  • T-wave alternans


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