Background: T wave alternans (TWA) is a significant total mortality (TM) predictor in post myocardial infarction patients. We examined the performance of TWA extracted from a Short Resting Holter ECG (SRH ECG-30 minutes duration) as TM predictor in Heart Failure (HF) patients. Methods: One hundred forty six Heart Failure patients (male 84%, mean age= 64±12 years, mean LVEF= 33±10%) underwent a SRH ECG recording for 30 minutes. These high resolution (1000 Hz) ECG signals were analysed with TWA Modified Moving Average method. After 42.1 months, 26 patients died. Results: Univariate analysis for Deceased and Alive groups: TWA: 31±18μV vs 25±13μV (p= 0.05), LVEF: 32±10% vs 34±9%(p< 0.5), Mean Heart Rate: 73±11bpm vs 69±12bpm (p= 0.2). SDNN/HRV: 45±42ms vs 41±29ms (p= 0.4). QRS: 123±26ms vs 119±29ms (p= 0.5). Multivariate Cox regression analysis adjusted for TWA, LVEF …