Heart and Vascular Research Center, Case Western Reserve University, Cleveland, Ohio 44109-1998, USA.
Heart Rhythm. 2009 Aug;6(8 Suppl):S56-61. doi: 10.1016/j.hrthm.2009.05.025. Epub 2009 Jun 23.
The proportion of cardiovascular deaths attributable to sudden cardiac death (SCD) is on the rise. Herein lies the rationale for developing risk stratification strategies to predict who will benefit from prophylactic implantable cardioverter-defibrillator (ICD) implantation. Current guidelines recommend prophylactic ICD therapy in patients with reduced left ventricular ejection fraction (LVEF). However, there are clear limitations in using LVEF alone to decide who should receive an ICD. There is mounting evidence that microvolt-level T-wave alternans (TWA) is an important marker of arrhythmic risk. TWA is appealing because it noninvasively probes the underlying electrophysiological substrate and has been linked to cellular mechanisms for arrhythmias. This review considers the clinical role of TWA for risk stratification of SCD.
心血管死亡中归因于心源性猝死（SCD）的比例正在上升。这就是制定风险分层策略以预测谁将受益于预防性植入式心脏复律除颤器（ICD）植入的基本原理。目前的指南建议在左心室射血分数（LVEF）降低的患者中进行预防性 ICD 治疗。然而，仅使用 LVEF 来决定谁应该接受 ICD 存在明显的局限性。越来越多的证据表明，微伏级 T 波交替（TWA）是心律失常风险的重要标志物。TWA 很有吸引力，因为它可以无创地探测潜在的电生理基质，并与心律失常的细胞机制有关。这篇综述考虑了 TWA 在 SCD 风险分层中的临床作用。
