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Effect of bundle branch block on microvolt T-wave alternans and electrophysiologic testing in patients with ischemic cardiomyopathy. 2007

Daniel P Morin, and Eran S Zacks, and Andreas C Mauer, and Shaun Ageno, and Matthew Janik, and Steven M Markowitz, and Suneet Mittal, and Sei Iwai, and Bindi K Shah, and Bruce B Lerman, and Kenneth M Stein
Maurice & Corinne Greenberg Division of Cardiology, Department of Medicine, Cornell University Medical Center, New York, NY 10021, USA.

BACKGROUND T-wave alternans (TWA) and electrophysiology study (EPS) are used for risk stratification for sudden death. OBJECTIVE The purpose of the study was to determine the effect of bundle branch block or intraventricular conduction delay on TWA and EPS. METHODS 386 patients with coronary artery disease, nonsustained ventricular tachycardia, and left ventricular ejection fraction < or =40% underwent TWA and EPS, and were followed for 40 +/- 19 months. RESULTS Patients with wide QRS were more likely than narrow QRS patients to have nonnegative TWA (77% vs 63%, P <.01) or positive EPS (60% vs 48%, P = .03). Nonnegative TWA predicted the combined endpoint of ventricular tachyarrhythmia or death in narrow QRS (HR = 1.64, P = .04) but not wide QRS patients (HR = 1.04, P = .91). Similarly, positive EPS predicted the combined endpoint in narrow QRS (HR = 2.28, P <.001) but not wide QRS patients (HR = 0.94, P = .84). In multivariate analysis, QRS width and TWA, as well as QRS width and EPS, were independent predictors of events. There was no TWA- or EPS-based difference in arrhythmia-free survival within any specific wide QRS morphology. CONCLUSIONS TWA and EPS are more often abnormal in patients with a wide QRS than in those with a narrow QRS. In patients with narrow QRS, both TWA and EPS stratify patients according to their risk of ventricular tachyarrhythmia or death. However, among patients with a wide QRS, regardless of specific QRS morphology, the risk is high and comparable regardless of TWA or EPS results. Therefore, the only truly low-risk group consists of those patients with negative test results and a narrow QRS.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002037 Bundle-Branch Block A form of heart block in which the electrical stimulation of HEART VENTRICLES is interrupted at either one of the branches of BUNDLE OF HIS thus preventing the simultaneous depolarization of the two ventricles. Fascicular Block,Anterior Fascicular Block,Bundle Branch Block,Left Bundle-Branch Block,Posterior Fascicular Block,Right Bundle-Branch Block,Anterior Fascicular Blocks,Block, Anterior Fascicular,Block, Bundle Branch,Block, Bundle-Branch,Block, Fascicular,Block, Left Bundle-Branch,Block, Posterior Fascicular,Block, Right Bundle-Branch,Blocks, Anterior Fascicular,Blocks, Bundle Branch,Blocks, Bundle-Branch,Blocks, Fascicular,Blocks, Left Bundle-Branch,Blocks, Posterior Fascicular,Blocks, Right Bundle-Branch,Branch Block, Bundle,Branch Blocks, Bundle,Bundle Branch Blocks,Bundle-Branch Block, Left,Bundle-Branch Block, Right,Bundle-Branch Blocks,Bundle-Branch Blocks, Left,Bundle-Branch Blocks, Right,Fascicular Block, Anterior,Fascicular Block, Posterior,Fascicular Blocks,Fascicular Blocks, Anterior,Fascicular Blocks, Posterior,Left Bundle Branch Block,Left Bundle-Branch Blocks,Posterior Fascicular Blocks,Right Bundle Branch Block,Right Bundle-Branch Blocks
D002304 Cardiac Pacing, Artificial Regulation of the rate of contraction of the heart muscles by an artificial pacemaker. Pacing, Cardiac, Artificial,Artificial Cardiac Pacing,Artificial Cardiac Pacings,Cardiac Pacings, Artificial,Pacing, Artificial Cardiac,Pacings, Artificial Cardiac
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D017202 Myocardial Ischemia A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (CORONARY ARTERY DISEASE), to obstruction by a thrombus (CORONARY THROMBOSIS), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (MYOCARDIAL INFARCTION). Heart Disease, Ischemic,Ischemia, Myocardial,Ischemic Heart Disease,Disease, Ischemic Heart,Diseases, Ischemic Heart,Heart Diseases, Ischemic,Ischemias, Myocardial,Ischemic Heart Diseases,Myocardial Ischemias
D022062 Electrophysiologic Techniques, Cardiac Methods to induce and measure electrical activities at specific sites in the heart to diagnose and treat problems with the heart's electrical system. Cardiac Electrophysiologic Techniques,Electrophysiologic Study, Cardiac,Atrial Electrogram,Bundle of His Electrogram,Cardiac Electrophysiologic Technics,Cardiac Electrophysiological Techniques,Electrophysiologic Techniques, Intracardiac,Electrophysiological Techniques, Cardiac,Electrophysiological Techniques, Intracardiac,His Bundle Electrogram,Intra-Atrial Electrogram,Intracardiac Electrogram,Intracardiac Electrophysiologic Techniques,Intracardiac Electrophysiological Technics,Intracardiac Electrophysiological Techniques,Programmed Electrostimulation, Cardiac,Transesophageal Electrophysiologic Study,Transesophageal Electrophysiological Study,Atrial Electrograms,Bundle Electrogram, His,Bundle Electrograms, His,Cardiac Electrophysiologic Studies,Cardiac Electrophysiologic Study,Cardiac Electrophysiologic Technic,Cardiac Electrophysiologic Technique,Cardiac Electrophysiological Technique,Cardiac Programmed Electrostimulation,Cardiac Programmed Electrostimulations,Electrogram Bundle, His,Electrogram Bundles, His,Electrogram, Atrial,Electrogram, His Bundle,Electrogram, Intra-Atrial,Electrogram, Intracardiac,Electrograms, Atrial,Electrograms, His Bundle,Electrograms, Intra-Atrial,Electrograms, Intracardiac,Electrophysiologic Studies, Cardiac,Electrophysiologic Studies, Transesophageal,Electrophysiologic Study, Transesophageal,Electrophysiologic Technic, Cardiac,Electrophysiologic Technics, Cardiac,Electrophysiologic Technique, Cardiac,Electrophysiologic Technique, Intracardiac,Electrophysiological Studies, Transesophageal,Electrophysiological Study, Transesophageal,Electrophysiological Technic, Intracardiac,Electrophysiological Technics, Intracardiac,Electrophysiological Technique, Cardiac,Electrophysiological Technique, Intracardiac,Electrostimulation, Cardiac Programmed,Electrostimulations, Cardiac Programmed,His Bundle Electrograms,His Electrogram Bundle,His Electrogram Bundles,Intra Atrial Electrogram,Intra-Atrial Electrograms,Intracardiac Electrograms,Intracardiac Electrophysiologic Technique,Intracardiac Electrophysiological Technic,Intracardiac Electrophysiological Technique,Programmed Electrostimulations, Cardiac,Studies, Cardiac Electrophysiologic,Studies, Transesophageal Electrophysiologic,Studies, Transesophageal Electrophysiological,Study, Cardiac Electrophysiologic,Study, Transesophageal Electrophysiologic,Study, Transesophageal Electrophysiological,Technic, Cardiac Electrophysiologic,Technic, Intracardiac Electrophysiological,Technics, Cardiac Electrophysiologic,Technics, Intracardiac Electrophysiological,Technique, Cardiac Electrophysiologic,Technique, Cardiac Electrophysiological,Technique, Intracardiac Electrophysiologic,Technique, Intracardiac Electrophysiological,Techniques, Cardiac Electrophysiologic,Techniques, Cardiac Electrophysiological,Techniques, Intracardiac Electrophysiologic,Techniques, Intracardiac Electrophysiological,Transesophageal Electrophysiologic Studies,Transesophageal Electrophysiological Studies

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