<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV>Dear Dr. Sunil Roy. MD, DM from India. Here Andres Ricardo Perez </DIV><DIV>Riera. You asked to Ramon Brugada about if is there any role for </DIV><DIV>microvolt T wave alternans for risk stratifications and to decide the </DIV><DIV>need for ICD?</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>T wave alternans (TWA) does not assess arrhythmic risk in patients with </DIV><DIV>Brugada syndrome (BrS). It is not an appropriate test to detect </DIV><DIV>arrhythmic risk in patients with BrS (1).</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Ikeda et al. enrolled 124 consecutive subjects with a Brugada-type ECG. </DIV><DIV>Prognostic indices included: age, sex, a family history of SD, syncopal </DIV><DIV>episodes, a spontaneous Type 1 ST-segment elevation, maximal magnitude </DIV><DIV>of ST-segment elevation, a spontaneous change in ST segment, a mean </DIV><DIV>QRSd, maximal QT interval, QT dispersion, LPs by SA-ECG, and TWA. Of the </DIV><DIV>12 risk indices, only a family history of SD, syncopal episodes, a </DIV><DIV>spontaneous type 1 ST-segment elevation, a spontaneous change in ST </DIV><DIV>segment, and LP had significant values (2).TWA does not assess </DIV><DIV>arrhythmic risk</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV> References</DIV><DIV>1) Kirchhof P, Eckardt L, Rolf S, T wave alternans does not </DIV><DIV>assess arrhythmic risk in patients with Brugada syndrome. Ann </DIV><DIV>Noninvasive Electrocardiol. 2004;9:162-165.20</DIV><DIV>2) Ikeda T, Takami M, Sugi K, et al. Noninvasive risk </DIV><DIV>stratification of subjects with a Brugada-type electrocardiogram and no </DIV><DIV>history of cardiac arrest. 20</DIV><DIV>All the best</DIV><DIV>AndrE9s Ricardo PE9rez Riera20</DIV><DIV>Chief of Electro-Vectocardiology Sector of the Discipline of </DIV><DIV>Cardiology,ABC Faculty of Medicine (FMABC), Foundation of ABC (FUABC)- </DIV><DIV>Santo AndrE9 -SE3o Paulo - Brazil. Rua SebastiE3o Afonso 885 - Zip </DIV><DIV>Code: 044417-100- Jardim Miriam S.P.- Brazil - Phone: 5504-6243 Fax: </DIV><DIV>5506-0398.</DIV><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR><DIV><DIV>El 14/10/2006, a las 9:09, SCD Symposium escribió:</DIV><BR class="Apple-interchange-newline"><BLOCKQUOTE type="cite"><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Forum of the ISHNE Sudden Cardiac Death World-Wide Internet Symposium</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">______________________________________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">SCD-HeFT trial shows ICD therapy mortality benefit:</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.scdheft.com">http://www.scdheft.com</A></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">______________________________________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; min-height: 14px; "><BR></DIV> <DIV>Dear Dr. Ramon Brugada,</DIV><DIV>As you have discussed in the answer to the question for an asymptomatic</DIV><DIV>patient with brugada syndrome, the use of EPS to risk stratify</DIV><DIV>asymptomatic patient is very controversial. The first symptom may be</DIV><DIV>sudden death in such patients. In such a scenario is there any role for</DIV><DIV>microvolt T wave alternans for risk stratifications and to decide the need</DIV><DIV>for ICD?</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV>Dr. Sunil Roy. MD, DM</DIV><DIV>Senior Lecturer in Cardiology</DIV><DIV>Medical college, Calicut, Kerala, India</DIV><DIV>Email: <A href="mailto:sunilroytn@calicutmedicalcollege.ac.in">sunilroytn@calicutmedicalcollege.ac.in</A></DIV><BR><BR><DIV> <SPAN class="Apple-style-span" style="border-collapse: separate; border-spacing: 0px 0px; color: rgb(0, 0, 0); font-family: Helvetica; font-size: 12px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; text-align: auto; -khtml-text-decorations-in-effect: none; text-indent: 0px; -apple-text-size-adjust: auto; text-transform: none; orphans: 2; white-space: normal; widows: 2; word-spacing: 0px; "><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">--</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Sergio<SPAN class="Apple-converted-space"> </SPAN>Dubner</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Scientific<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; font: normal normal normal 13px/normal Lucida Grande; min-height: 16px; ; font-family: Lucida Grande; font-size: 13px; "><BR style="font-family: Lucida Grande; font-size: 13px; "></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Dr.<SPAN class="Apple-converted-space"> </SPAN>Edgardo<SPAN class="Apple-converted-space"> </SPAN>Schapachnik</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">President<SPAN class="Apple-converted-space"> </SPAN>of<SPAN class="Apple-converted-space"> </SPAN>Steering<SPAN class="Apple-converted-space"> </SPAN>Committee</DIV><DIV><BR class="khtml-block-placeholder"></DIV><DIV><BR class="khtml-block-placeholder"></DIV><BR class="Apple-interchange-newline"></SPAN> </DIV><BR><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">_______________________________________________</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; ">Scd-forum mailing list</DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="mailto:Scd-forum@scd-symposium.org">Scd-forum@scd-symposium.org</A></DIV><DIV style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; "><A href="http://www.grupoakros.com.ar/mailman/listinfo/scd-forum">http://www.grupoakros.com.ar/mailman/listinfo/scd-forum</A></DIV> </BLOCKQUOTE></DIV><BR></BODY></HTML>