NEW YORK, NY, January 27,
2006 - Last year, about 170,000 people in North America had devices
surgically implanted to stop potentially fatal arrhythmias. For many,
these were life-saving, but for others they were unnecessary,
uncomfortable, and sometimes dangerous. Now a new, noninvasive
test may help determine which patients are most likely to benefit from
the device, known as implantable cardiac defibrillator (ICD). A
large, multicenter, NIH-sponsored study coordinated by Columbia
University Medical Center researchers reported on the accuracy of the
test was and was published in the latest issue of the Journal of the
American College of Cardiology.
The test, known as the Microvolt T-wave Alternans (MTWA) test, measures
the electrical activity in the heart while the patient is performing
light exercise on a stationary bicycle or treadmill. It can
detect an electrical signal that can identify a heart likely to
generate a life-threatening rhythm disturbance, a signal too slight to
be detected by the traditional electrocardiogram (ECG). The MWTA
test will be most helpful for patients who are at risk but have not yet
had a cardiac arrest. If an arrhythmia occurred in a patient who
had an ICD, the device would deliver a pulse of electrical current
through the heart in order to stop the potentially fatal arrhythmia.
“Until now, it’s been difficult to determine which patients need
prophylactic ICDs and which are unlikely to be helped by them, but this
noninvasive and inexpensive office-based test can identify up to a
third of candidates for the devices who are not likely to benefit from
them,” said J. Thomas Bigger, MD, professor of medicine and of
pharmacology at Columbia University Medical Center, who conducted the
research.
The study followed 549 patients from 11 North American clinical centers
for two years following an MWTA test.
The MTWA test might also reduce healthcare expenses, since ICD
implantation costs roughly $50,000 and the test costs about $400.
But as doctors become more confident about accurately targeting which
patients would be helped by the devices, the number of prophylactic
implantations may increase.
The test does not have national coverage by Medicare intermediaries,
but the Centers for Medicare and Medicaid Services (CMS) is currently
reviewing its coverage policy for the MTWA test and is expected to make
a decision on coverage in March.
The MWTA test was developed by Dr. Richard Cohen at the Massachusetts
Institute of Technology, and is made by Cambridge Heart Inc. of
Bedford, Massachusetts.
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