Noninvasive test aims to prevent sudden cardiac death

Most of us take a steady heartbeat -- about 100,000 beats per day in near-perfect rhythm -- for granted. But some people may suddenly develop a dangerous and irregular rhythm that could make the heart beat wildly out of control. Identifying people with this electrical glitch that puts them at risk, however, could allow them to receive implantable defibrillators, possibly saving thousands of lives each year.

A researcher at Washington University School of Medicine in St. Louis has invented the first noninvasive test that identifies this glitch in advance of a patient's first rhythm problem. The test is called the alternans test because it measures a tiny fluctuation in heartbeat called the T-wave alternans. Joseph M. Smith, M.D., Ph.D., associate professor of medicine and biomedical engineering, invented the test while he was at the Massachusetts Institute of Technology, and he hopes it will be used widely to identify those at risk of sudden death. Cambridge Heart Inc. developed the test for commercial use, and the FDA approved it in April 1999.

Smith and colleagues described their latest study at the North American Society of Pacing and Electrophysiology in Toronto, Canada, in May 1999. They determined how T-wave alternans changes as heart rate changes, which will allow for improvements in the test's accuracy.

"Because the consequence of a positive alternans test may be implantation of a defibrillator in some patients, we want to make the test as accurate as possible," Smith said.

Shortfalls of traditional testing

Most cardiac patients undergo a stress test to evaluate problems associated with insufficient blood supply to the heart -- a plumbing problem. Such tests are of little value in detecting the electrical problems responsible for sudden death, however. Studying the electrical system of the heart typically requires an invasive test in which electrode catheters are plac

Contact: Linda Sage
Washington University in St. Louis

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