Open Access

REVIEW

The Relationship between T-Wave Alternans and Adverse Cardiac Events in Patients with Congenital Long QT Syndrome: A Systematic Review and Meta-Analysis

Ying Yang^1,#, Tingting Lv^2,#, Siyuan Li¹, Ping Zhang^1,2,*

1 School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
2 Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China

* Corresponding Author: Ping Zhang. Email:
# These authors contributed equally to this work (First author)

Congenital Heart Disease 2022, 17(5), 557-567. https://doi.org/10.32604/CHD.2021.017292

Received 29 April 2021; Accepted 18 June 2021; Issue published 06 September 2022

Abstract

Background: T-wave alternans (TWA) is a risk factor of ventricular arrhythmias or sudden cardiac death (SCD) in patients with ischemic cardiomyopathy. Nevertheless, the relationship between TWA and adverse cardiac events (ACE) in patients with congenital long QT syndrome (LQT) remains controversial. Methods: A systematic electronic search of PubMed, Embase and the Cochrane Library was conducted from database inception dates to 28 April 2021 and assessed the relationship between TWA and ACE in patients with LQTS. Sub-group analysis evaluated the association between microvolt TWA (MTWA) and ACE in different monitoring models and ECGlead numbers. Results: A pooled analysis of seven studies of 625 patients with LQTS showed that TWA was significantly associated with ACE (OR 3.16, 95%CI 1.86–5.37, P < 0.001). Advanced analysis showed that macroscopic TWA was significantly related to ACE (OR 6.01, 95%CI 2.96–12.21, P < 0.001), while MTWA did not (OR 0.92, 95%CI 0.37–2.30, P = 0.85). Sub-group analysis showed that MTWA recorded in 24 h continuous ECG (OR 6.79, 95%CI 0.80–57.75, P = 0.08) might have a stronger association with ACE than recorded in stress ECG (OR 0.28, 95%CI 0.07–1.10, P = 0.07). No difference was observed between MTWA measured in multi-lead ECG and limited ECG leads (P = 0.15). Conclusions: Macroscopic TWA was significantly related to ACE in patients with LQTS. In terms of MTWA, MTWA recorded in 24 h continuous ECG might have a stronger association with ACE than stress ECG, but still deserves further evaluation.

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