The Usefulness of Microvolt T-Wave Alternans in the Risk Stratification of Patients with Hypertrophic Cardiomyopathy

Background: Patients with hypertrophic cardiomyopathy are prone to ventricular arrhythmias and sudden death. Identifying patients at risk of sudden death is difficult. Objectives: To determine whether microvolt T-wave alternans detected during exercise or rapid atrial pacing can identify patients with HCM who are at risk of ventricular arrhythmias and sudden death. Methods: This prospective observational study included 21 patients with HCM: the disease was abstructive in 11, non-obstructive in 9 and apical in 1. TWA was measured while the patients were on anti-arrhythmic medication. Results: TWA was positive in 9 patients (43%) and negative in 12 (57%). Three patients were resuscitated after sudden death before their enrollment in the study and two patients developed ventricular tachycardia and fibrillation respectively during the study period. After combining the endpoint of sudden death from a ventricular arrhythmia and the presence of ventricular arrhythmias on a Hotter monitor, there was no significant correlation between the presence of a positive TWA and the presence of ventricular arrhythmias on the Holter monitor or a history of sudden death. Conclusion: TWA cannot be used as a non-invasive test for detecting patients with HCM and electrical instability. TWA is not useful for predicting sudden death in patients with HCM.