Background: congestive heart failure (CHF) is associated with a high incidence of sudden death (SD) due to ventricular tachyarrhythmias (VT/VF). At present, there is no method to accurately predict risk in these pts. The present prospective study assessed the predictive value of T wave alternans measured during exercise stress (TWA; spectral method) in these pts. Methods and results: We studied 81 pts with CHF, no recent myocardial infarction, and no history of VT/VF. Pts were 80% male, 58% with coronary disease, 36% with dilated cardiomyopathy, and had a mean age of 55 + 10 years. Mean LVEF was 28 + 7%. The follow-up averaged 453 + 283 days. TWA was positive in 37, negative in 23, and indeterminate in 6 pts. 15 pts could not exercise adequately. LVEF was not significantly different between TWA positive and negative pts. A total of 7 prespecified endpoints occurred during follow-up (2 non-fatal VT/VF, 3 SD, 2 cardiac deaths). Kaplan-Meier analysis revealed significant differences in event-free survival between TWA positive and negative pts (fig).

Conclusion: TWA appears to identify CHF pts at risk for arrhythmic events and cardiac death.

1 Oak Park Drive

Bedford, MA 01730

781-271-1200