https://sudepwiki.pathology.jhmi.edu/index.php?title=Baseline_elevation_and_reduction_in_cardiac_electrical_instability_assessed_by_quantitative_T-wave_alternans_in_patients_with_drug-resistant_epilepsy_treated_with_vagus_nerve_stimulation_in_the_AspireSR_E-36_trial&feed=atom&action=history
Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with drug-resistant epilepsy treated with vagus nerve stimulation in the AspireSR E-36 trial - Revision history
2024-03-29T13:44:50Z
Revision history for this page on the wiki
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https://sudepwiki.pathology.jhmi.edu/index.php?title=Baseline_elevation_and_reduction_in_cardiac_electrical_instability_assessed_by_quantitative_T-wave_alternans_in_patients_with_drug-resistant_epilepsy_treated_with_vagus_nerve_stimulation_in_the_AspireSR_E-36_trial&diff=1296&oldid=prev
Alano at 17:11, 17 June 2019
2019-06-17T17:11:49Z
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<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">← Older revision</td>
<td colspan="2" style="background-color: #fff; color: #202122; text-align: center;">Revision as of 17:11, 17 June 2019</td>
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<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">''Verrier RL, Nearing BD, Olin B, et al. (2016) Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with drug-resistant epilepsy treated with vagus nerve stimulation in the AspireSR E-36 trial. Epilepsy Behav. 2016 Sep;62:85-9.''</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">{{Reference</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''[https://ac.els-cdn.com/S1525505016301810/1-s2.0-S1525505016301810-main.pdf?_tid</del>=<del class="diffchange diffchange-inline">86b06389-3786-4de7-9fd6-b642517a82ba&acdnat=1531173089_588ec3d2f292a484f00104cb1d7817c0 Link to Article]'''</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|reference</ins>=</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''Abstract:''' OBJECTIVE: Reports of cardiac arrhythmias </del>and cardiac <del class="diffchange diffchange-inline">pathology at postmortem examination of patients with epilepsy suggest a possible cardiac component of risk for sudden unexpected death in epilepsy (SUDEP). </del>T-wave alternans <del class="diffchange diffchange-inline">(TWA) is an established marker of cardiac electrical instability and risk for sudden death </del>in patients with <del class="diffchange diffchange-inline">cardiovascular disease. We determined the TWA level before </del>vagus nerve stimulation <del class="diffchange diffchange-inline">(VNS) system implantation and subsequently the effect of VNS on TWA </del>in <del class="diffchange diffchange-inline">patients with drug-resistant epilepsy. METHODS: Patients (n=28) from </del>the <del class="diffchange diffchange-inline">Seizure Detection and Automatic Magnet Mode Performance Study (</del>E-36<del class="diffchange diffchange-inline">), a clinical </del>trial <del class="diffchange diffchange-inline">of the AspireSR® VNS Therapy System® (NCT01325623), were monitored with ambulatory electrocardiograms (ECGs) ~2weeks before de novo VNS system implantation and following 2- to 4-week VNS titration during a protocol-specified 3- to 5-day epilepsy monitoring unit stay with concurrent EEG/ECG recordings. The TWA level was assessed interictally by the Modified Moving Average (MMA) method. RESULTS: At preimplantation baseline, TWA was elevated above the 47-μV abnormality cutpoint in 23 (82%) patients with drug-resistant epilepsy. In 16 (70%) patients, TWA level was reduced during VNS treatment to <47μV, thereby converting positive TWA test results to negative. Peak TWA level in all 28 patients improved (group mean, 43%, from 72±4</del>.<del class="diffchange diffchange-inline">3 to 41±2</del>.<del class="diffchange diffchange-inline">3μV</del>; <del class="diffchange diffchange-inline">p<0.0001). Vagus nerve stimulation was not associated with reduced heart rate (77±1.4 to 75±1.4beats/min; p=0.18). Heart rate variability was unchanged. SIGNIFICANCE</del>: <del class="diffchange diffchange-inline">These findings suggest significant interictal cardiac electrical instability in this population of patients with drug</del>-<del class="diffchange diffchange-inline">resistant epilepsy and suggest that VNS may be a novel approach to reducing risk</del>.</div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">Verrier RL, Nearing BD, Olin B, et al. (2016) Baseline elevation </ins>and <ins class="diffchange diffchange-inline">reduction in </ins>cardiac <ins class="diffchange diffchange-inline">electrical instability assessed by quantitative </ins>T-wave alternans in patients with <ins class="diffchange diffchange-inline">drug-resistant epilepsy treated with </ins>vagus nerve stimulation in the <ins class="diffchange diffchange-inline">AspireSR </ins>E-36 trial. <ins class="diffchange diffchange-inline">Epilepsy Behav</ins>. <ins class="diffchange diffchange-inline">2016 Sep</ins>;<ins class="diffchange diffchange-inline">62</ins>:<ins class="diffchange diffchange-inline">85</ins>-<ins class="diffchange diffchange-inline">9</ins>.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''Keywords:''' Biomarker; Epilepsy; Risk reduction; Sudden unexpected death in epilepsy; T-wave alternans</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|url=</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>==<del class="diffchange diffchange-inline">Context==</del></div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">https://ac.els-cdn.com/S1525505016301810/1-s2.0-S1525505016301810-main.pdf?_tid</ins>=<ins class="diffchange diffchange-inline">86b06389-3786-4de7-9fd6-b642517a82ba&acdnat</ins>=<ins class="diffchange diffchange-inline">1531173089_588ec3d2f292a484f00104cb1d7817c0</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f8f9fa; color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #eaecf0; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>==<del class="diffchange diffchange-inline">Comments</del>==</div></td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|abstract</ins>=</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">OBJECTIVE: Reports of cardiac arrhythmias and cardiac pathology at postmortem examination of patients with epilepsy suggest a possible cardiac component of risk for sudden unexpected death in epilepsy (SUDEP). T-wave alternans (TWA) is an established marker of cardiac electrical instability and risk for sudden death in patients with cardiovascular disease. We determined the TWA level before vagus nerve stimulation (VNS) system implantation and subsequently the effect of VNS on TWA in patients with drug-resistant epilepsy. METHODS: Patients (n</ins>=<ins class="diffchange diffchange-inline">28) from the Seizure Detection and Automatic Magnet Mode Performance Study (E-36), a clinical trial of the AspireSR® VNS Therapy System® (NCT01325623), were monitored with ambulatory electrocardiograms (ECGs) ~2weeks before de novo VNS system implantation and following 2- to 4-week VNS titration during a protocol-specified 3- to 5-day epilepsy monitoring unit stay with concurrent EEG/ECG recordings. The TWA level was assessed interictally by the Modified Moving Average (MMA) method. RESULTS: At preimplantation baseline, TWA was elevated above the 47-μV abnormality cutpoint in 23 (82%) patients with drug-resistant epilepsy. In 16 (70%) patients, TWA level was reduced during VNS treatment to <47μV, thereby converting positive TWA test results to negative. Peak TWA level in all 28 patients improved (group mean, 43%, from 72±4.3 to 41±2.3μV; p<0.0001). Vagus nerve stimulation was not associated with reduced heart rate (77±1.4 to 75±1.4beats/min; p</ins>=<ins class="diffchange diffchange-inline">0.18). Heart rate variability was unchanged. SIGNIFICANCE: These findings suggest significant interictal cardiac electrical instability in this population of patients with drug-resistant epilepsy and suggest that VNS may be a novel approach to reducing risk.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|keywords</ins>=</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">Biomarker; Epilepsy; Risk reduction; Sudden unexpected death in epilepsy; T-wave alternans</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|context=</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">|comments=</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color: #202122; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">}}</ins></div></td></tr>
</table>
Alano
https://sudepwiki.pathology.jhmi.edu/index.php?title=Baseline_elevation_and_reduction_in_cardiac_electrical_instability_assessed_by_quantitative_T-wave_alternans_in_patients_with_drug-resistant_epilepsy_treated_with_vagus_nerve_stimulation_in_the_AspireSR_E-36_trial&diff=1111&oldid=prev
Ycarmen1: Created page with "''Verrier RL, Nearing BD, Olin B, et al. (2016) Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with d..."
2018-07-09T21:49:44Z
<p>Created page with "''Verrier RL, Nearing BD, Olin B, et al. (2016) Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with d..."</p>
<p><b>New page</b></p><div>''Verrier RL, Nearing BD, Olin B, et al. (2016) Baseline elevation and reduction in cardiac electrical instability assessed by quantitative T-wave alternans in patients with drug-resistant epilepsy treated with vagus nerve stimulation in the AspireSR E-36 trial. Epilepsy Behav. 2016 Sep;62:85-9.''<br />
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'''[https://ac.els-cdn.com/S1525505016301810/1-s2.0-S1525505016301810-main.pdf?_tid=86b06389-3786-4de7-9fd6-b642517a82ba&acdnat=1531173089_588ec3d2f292a484f00104cb1d7817c0 Link to Article]'''<br />
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'''Abstract:''' OBJECTIVE: Reports of cardiac arrhythmias and cardiac pathology at postmortem examination of patients with epilepsy suggest a possible cardiac component of risk for sudden unexpected death in epilepsy (SUDEP). T-wave alternans (TWA) is an established marker of cardiac electrical instability and risk for sudden death in patients with cardiovascular disease. We determined the TWA level before vagus nerve stimulation (VNS) system implantation and subsequently the effect of VNS on TWA in patients with drug-resistant epilepsy. METHODS: Patients (n=28) from the Seizure Detection and Automatic Magnet Mode Performance Study (E-36), a clinical trial of the AspireSR® VNS Therapy System® (NCT01325623), were monitored with ambulatory electrocardiograms (ECGs) ~2weeks before de novo VNS system implantation and following 2- to 4-week VNS titration during a protocol-specified 3- to 5-day epilepsy monitoring unit stay with concurrent EEG/ECG recordings. The TWA level was assessed interictally by the Modified Moving Average (MMA) method. RESULTS: At preimplantation baseline, TWA was elevated above the 47-μV abnormality cutpoint in 23 (82%) patients with drug-resistant epilepsy. In 16 (70%) patients, TWA level was reduced during VNS treatment to <47μV, thereby converting positive TWA test results to negative. Peak TWA level in all 28 patients improved (group mean, 43%, from 72±4.3 to 41±2.3μV; p<0.0001). Vagus nerve stimulation was not associated with reduced heart rate (77±1.4 to 75±1.4beats/min; p=0.18). Heart rate variability was unchanged. SIGNIFICANCE: These findings suggest significant interictal cardiac electrical instability in this population of patients with drug-resistant epilepsy and suggest that VNS may be a novel approach to reducing risk.<br />
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'''Keywords:''' Biomarker; Epilepsy; Risk reduction; Sudden unexpected death in epilepsy; T-wave alternans<br />
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==Context==<br />
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==Comments==</div>
Ycarmen1