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Linkage Between Mechanical and Electrical Alternans in Patients with Chronic Heart Failure
Author(s) -
KODAMA MAKOTO,
KATO KIMINORI,
HIRONO SATORU,
OKURA YUJI,
HANAWA HARUO,
YOSHIDA TSUYOSHI,
HAYASHI MANABU,
TACHIKAWA HITOSHI,
KASHIMURA TAKESHI,
WATANABE KENICHI,
AIZAWA YOSHIFUSA
Publication year - 2004
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2004.03016.x
Subject(s) - t wave alternans , medicine , cardiology , heart failure , ejection fraction , ventricular tachycardia , ventricular fibrillation , dobutamine , fibrillation , sudden cardiac death , population , atrial fibrillation , hemodynamics , environmental health
Progressive heart failure and ventricular fibrillation are major causes of death in patients with chronic heart failure. Mechanical alternans (pulsus alternans) has been observed in patients with severe congestive heart failure. Visible T wave alternans occasionally is a precursor of ventricular fibrillation. We investigated the occurrence of both cardiac alternans in 94 patients with chronic heart failure. Methods and Results: Mean left ventricular ejection fraction (LVEF) of the study population was 35 ± 10%. Mechanical alternans was detected in left ventricular pressure during diagnostic cardiac catheterization. Only sustained mechanical alternans was included in the study. Visible T wave alternans, not microvolt alternans, was noted on standard surface ECG. Cardiac alternans was examined at rest, during physiologic tachycardia, and during stepwise dobutamine loading (2–4–8 μg/kg/min). Prevalences of mechanical and electrical alternans were 19.1% and 4.4% at rest, 45.5% and 8.0% during physiologic tachycardia, and 62.1% and 9.5% under dobutamine loading. Overall, 70 patients (74.5%) showed mechanical alternans and 10 patients (10.6%) showed T wave alternans. T wave alternans always appeared with large mechanical alternans. Among patients with mechanical alternans, cases with T wave alternans showed lower LVEF than those without (27.5 ± 4.4 and 35.1 ± 10.2, P < 0.002). Conclusion: Visible T wave alternans was detectable in patients with chronic heart failure, especially under tachycardia or catecholamine exposure. Investigating mechanical and mechanoelectrical alternans may bring new insights into the management of patients with chronic heart failure. (J Cardiovasc Electrophysiol, Vol. 15, pp. 295‐299, March 2004)