Circadian Variation of the Incidence of Time-Domain T-Wave Alternans and Sinus Cycle Length at TWA in Patient with Implantable Cardiovereter Defibrillator

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Time-domain TWA is useful for identifying patients at risk for life threatening arrhythmia. The purpose of this study was to evaluate circadian variation of incidence of TWA in patients with ICD. Method: Forty two sinus rhythm patients implanted ICD, were underwent Holter ECG recordings. TWA was assessed with the modified moving average method. TWA was defined as positive when the maximal voltage was ≥65 µV. Circadian variation of time of maximal voltage of TWA was evaluated. All subjects were divided into two groups by sinus cycle length (SCL) at maximal TWA recorded, 23 with SCL ≥800 ms (group A), 17 with SCL <800 ms (group B). Cardiac function, frequency of appropriate ICD therapy were compared between two groups. Results: TWA positive rate was 83% (35/42) in all subjects. Maximal voltage of TWA was more frequent in day time than night time. LVEF was higher in group B (57±12%) than group A (47±14%) p<0.022, appropriate ICD therapy was more frequent in group A (12/23; 56.5%) than group B (1/17; 5.9%) p=0.0009. Conclusion: TWA was recorded more frequent in day time, but TWA with longer SCL suggests lower cardiac function and frequent ICD therapy.
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