CPT® Code 93025

1. Indications

The microvolt T-wave alternans test is indicated for patients who present with specific risk factors that may predispose them to sudden cardiac arrest. These indications include:

• History of Heart Attack Patients who have previously experienced a myocardial infarction may be at higher risk for arrhythmias and sudden cardiac events.
• Heart Failure Individuals diagnosed with heart failure often have compromised cardiac function, which can lead to arrhythmias.
• Left Ventricular Dysfunction Patients exhibiting left ventricular dysfunction are at an increased risk for developing life-threatening arrhythmias.
• Unexplained Syncope Episodes of unexplained loss of consciousness may indicate underlying arrhythmias that could lead to sudden cardiac arrest.
• Family History of Sudden Cardiac Arrest A familial predisposition to sudden cardiac events can warrant assessment through this testing.

2. Procedure

The microvolt T-wave alternans testing procedure involves several key steps to ensure accurate assessment of the patient's cardiac function.

• Electrode Placement A total of 14 electrodes are strategically placed on the patient's torso. This includes seven standard ECG electrodes and seven specialized microvolt T-wave alternans sensors, which are essential for detecting subtle changes in the T-wave segment of the ECG.
• Patient Preparation The patient is prepared for the test by ensuring that they are comfortable and informed about the procedure. It is important to explain the process and what to expect during the test.
• Exercise or Pharmacological Stimulation The patient is then asked to walk on a treadmill, with the speed gradually increased to elevate the heart rate. Alternatively, if the patient is unable to exercise, the heart rate may be increased through pharmacological agents or by using a pacemaker to simulate the desired heart rate.
• Monitoring ECG Changes Throughout the test, the ECG is continuously monitored to detect any changes in the T-wave. The test continues until significant T-wave alterations are observed or until the patient reaches the target heart rate without any detectable changes.
• Data Analysis After the completion of the test, the physician reviews the ECG recordings. The analysis focuses on identifying any microvolt T-wave alternans that may indicate an increased risk for ventricular arrhythmias.
• Report Generation Finally, the physician compiles a detailed interpretation of the findings, which is documented in a written report for further evaluation and management.

3. Post-Procedure

Post-procedure care for patients undergoing microvolt T-wave alternans testing typically involves monitoring for any immediate adverse effects, although the procedure is generally well-tolerated. Patients may resume normal activities unless otherwise advised by their healthcare provider. The physician will review the results of the test with the patient, discussing any findings that may indicate a need for further evaluation or intervention. It is essential for patients to follow up with their healthcare provider to discuss the implications of the test results and any necessary next steps in their cardiac care.