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. 2010 May-Jun;43(3):251-9.
doi: 10.1016/j.jelectrocard.2009.12.009. Epub 2010 Jan 25.

Association of Holter-based measures including T-wave alternans with risk of sudden cardiac death in the community-dwelling elderly: the Cardiovascular Health Study

Phyllis K Stein  1 , Devang Sanghavi, Nona Sotoodehnia, David S Siscovick, John Gottdiener
Affiliations

Association of Holter-based measures including T-wave alternans with risk of sudden cardiac death in the community-dwelling elderly: the Cardiovascular Health Study

Phyllis K Stein et al. J Electrocardiol. 2010 May-Jun.

Abstract

Background: Sudden cardiac death (SCD) can be the first manifestation of cardiovascular disease. Development of screening methods for higher/lower risk is critical.

Methods: The Cardiovascular Health Study is a population-based study of risk factors for coronary heart disease and stroke those 65 years or older. Forty-nine (of 1649) with usable Holters and in normal sinus rhythm had SCD during follow-up and were matched with 2 controls, alive at the time of death of the case and not experiencing SCD on follow-up. Univariate and multivariate conditional logistic regression determined the association of Holter-based information and SCD.

Results: In univariate models, the upper half of ventricular premature contraction (VPC) counts, abnormal heart rate turbulence, decreased normalized low-frequency power, increased T-wave alternans (TWA), and decreased the short-term fractal scaling exponent (DFA(1)) were associated with SCD, but time domain heart rate variability was not. In multivariate models, the upper half of VPC counts (odds ratio [OR], 6.6) and having TWA of 37 muV or greater on channel 2 (OR, 4.8) were independently associated with SCD. Also, the upper half of VPC counts (OR, 6.9) and having a DFA(1) of less than 1.05 (OR, 5.0) were independently associated with SCD. When additive effects were explored, having both higher VPCs and higher TWA was associated with an OR of 8.2 for SCD compared with 2.6 for having either. Also, having both higher VPCs and lower DFA(1) was associated with an OR of 9.6 for SCD compared with 3.1 for having either.

Conclusions: Results support a potential role for 24-hour Holter recordings to identify older adults at increased or lower risk of SCD.

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Conflict of interest statement

Disclosures: All authors declare no conflicts of interest and have nothing to declare financially.

Figures

Figure 1
Figure 1
Holter-based T-wave alternans in two CHS participants. Small boxes are the QRS-aligned templates generated by modified moving average analysis, which show the measurement of the maximum difference between successive sinus beats. The associated ECG strip is shown below it. TWA is 58 µV in the top figure and 61 µV in the bottom one.
Figure 2
Figure 2
Age-adjusted survival curves for SCD for participants with VPCs in the lower two vs. the upper two quartiles of the CHS cohort.
Figure 3
Figure 3
Age-adjusted survival curves for SCD for participants with Holter TWA above and below the cutpoint of 37 µV on channel 2.
Figure 4
Figure 4
Age-adjusted survival curves for the combined risk for SCD of having VPCs in the upper half and/or with Holter TWA above the cutpoint of 37 µV on channel 2.
Figure 5
Figure 5
Age-adjusted survival curves for the combined risk of SCD for participants with VPCs in the upper half and/or DFA1 <1.015.
See this image and copyright information in PMC

Comment in

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