{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T08:23:53Z","timestamp":1765355033912,"version":"3.41.2"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,6,4]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">New methods to identify patients who benefit from a primary prophylactic implantable cardioverter\u2010defibrillator (ICD) are needed. T\u2010wave alternans (TWA) has been shown to associate with arrhythmogenesis of the heart and sudden cardiac death. We hypothesized that TWA might be associated with benefit from ICD implantation in primary prevention.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              In the EU\u2010CERT\u2010ICD (European Comparative Effectiveness Research to Assess the Use of Primary Prophylactic Implantable Cardioverter\u2010Defibrillators) study, we prospectively enrolled 2327 candidates for primary prophylactic ICD. A 24\u2010hour Holter monitor reading was taken from all recruited patients at enrollment. TWA was assessed from Holter monitoring using the modified moving average method. Study outcomes were all\u2010cause death, appropriate shock, and survival benefit. TWA was assessed both as a contiguous variable and as a dichotomized variable with cutoff points &lt;47\u2009\u03bcV and &lt;60\u2009\u03bcV. The final cohort included 1734 valid T\u2010wave alternans samples, 1211 patients with ICD, and 523 control patients with conservative treatment, with a mean follow\u2010up time of 2.3\u2009years. TWA \u226560\u2009\u03bcV was a predicter for a higher all\u2010cause death in patients with an ICD on the basis of a univariate Cox regression model (hazard ratio, 1.484 [95% CI, 1.024\u20132.151];\n              <jats:italic>P<\/jats:italic>\n              =0.0374; concordance statistic, 0.51). In multivariable models, TWA was not prognostic of death or appropriate shocks in patients with an ICD. In addition, TWA was not prognostic of death in control patients. In a propensity score\u2013adjusted Cox regression model, TWA was not a predictor of ICD benefit.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">T\u2010wave alternans is poorly prognostic in patients with a primary prophylactic ICD. Although it may be prognostic of life\u2010threatening arrhythmias and sudden cardiac death in several patient populations, it does not seem to be useful in assessing benefit from ICD therapy in primary prevention among patients with an ejection fraction of \u226435%.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032465","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T10:07:31Z","timestamp":1716890851000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Lack of Prognostic Value of T\u2010Wave Alternans for Implantable Cardioverter\u2010Defibrillator Benefit in Primary Prevention"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6536-2491","authenticated-orcid":false,"given":"Ari","family":"Pelli","sequence":"first","affiliation":[{"name":"Research Unit of Internal Medicine, Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuomas V.","family":"Kentt\u00e4","sequence":"additional","affiliation":[{"name":"Research Unit of Internal Medicine, Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8896-1281","authenticated-orcid":false,"given":"M. Juhani","family":"Junttila","sequence":"additional","affiliation":[{"name":"Research Unit of Internal Medicine, Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland"},{"name":"Biocenter Oulu University of Oulu Oulu Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2035-3682","authenticated-orcid":false,"given":"Cynthia","family":"Huber","sequence":"additional","affiliation":[{"name":"Division of Cardiology University Medical Center G\u00f6ttingen Heart Center G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9647-1058","authenticated-orcid":false,"given":"Simon","family":"Schl\u00f6gl","sequence":"additional","affiliation":[{"name":"Division of Cardiology University Medical Center G\u00f6ttingen Heart Center G\u00f6ttingen Germany"},{"name":"DZHK (German Center for Cardiovascular Research) partner site G\u00f6ttingen 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