T-wave Alternans Assessment With Modified Moving Average Analysis Complements Electrophysiologic Study For The Prediction Of Ventricular Tachyarrhythmias In Patients With Arrhythmogenic Right Ventricular Cardiomyopathy:A Long-term Follow-up Study

[Objective]The long-term predicted value of microvolt T-wave alternans(MTWA)for ventricular tachyarrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC)remains unclear.Our study explored the characteristics of MTWA and its prognostic value when combined with an electrophysiologic study(EPS)in ARVC patients.[Methods]All patients underwent noninvasive MTWA examination with modified moving average(MMA)analysis and an EPS.A positive event was defined as the first occurrence of sudden cardiac death(SCD),documented sustained ventricular tachycardia(VT),ventricular fibrillation(VF),or the administration of appropriate implantable cardioverter defibrillator(ICD)therapy including shock or antitachycardia pacing.[Results]Thirty-five ARVC patients(age 38.6±11.0 years;28 males)with preserved left ventricular(LV)function were recruited.The maximal TWA value(Max Valt)was17.0(11.0-27.0)?V.Sustained VT was induced in 22 patients by the EPS.During a median follow-up of 99.9±7.7 months,15(42.9%)patients had positive clinical events.When inducible VT was combined with the Max Valt,the area under the curve(AUC)improved from 0.739 to 0.797.The receiver operating characteristic(ROC)curve showed that a Max Valt of 23.5 ?V was the optimal cutoff value to identify positive events.The multivariate Cox regression model for survival showed that MTWA(Max Valt,HR,1.06;95% CI,1.01-1.11;P=0.01)and inducible VT(HR,5.98;95% CI,1.33-26.8;P=0.01)independently predicted positive events in ARVC patients.[Conclusion]MTWA assessment with MMA analysis complemented by an EPS could effectively predict the long-term prognosis for ARVC patients with preserved LV function.