Microvolt T-wave alternans testing has no role at present in guiding therapy for patients at high risk of ventricular arrhythmias

摘要

Verrier et al. (1) review the evidence regarding clinical utility of microvolt T-wave alternans (MTWA) testing, suggesting that it may be used to identify patients at risk of life-threatening ventricular arrhythmias. In light of conflicting results from recent clinical studies, an overview for the practicing clinician is much needed. However, there are important issues that are not addressed. In their review, the authors do not mention that patients with atrial fibrillation, which is highly prevalent in heart failure (10% to 50%) (2), are unsuitable for spectral MTWA testing. Furthermore, exercise intolerance and continuous ventricular pacing also preclude MTWA testing. Even if MTWA was demonstrated to improve risk stratification, alternative strategies would be required for the significant proportion of ineligible patients.