Which patients may benefit from MTWA-guided antiarrhythmic therapy?
In summary, the study of Cantillon et al. (12) extends our knowledge about the use of MTWA in patients with LV dysfunction and additional risk profiles (NSVT or syncope). In that population, MTWA alone may not be sufficiently effective to select patients to benefit (or not) from prophylactic ICD therapy. Putting the currently available studies of MTWA in LV dysfunction in perspective, it can be concluded that the predictive efficacy of the test is largely dependent on the patient population studied. Because the pretest probability of a ventricular tachyarrhythmic event differs according to the underlying pathology of LV dysfunction and to the presence or absence of additional clinical risk features, recommendations on the use of MTWA should be based on interventional trials in well defined patient populations. Such studies are currently underway (15 17) and may help to define the role of MTWA in a strategy of cost-effective primary preventive ICD therapy.
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