An implantable cardiac device that delivers electrical therapy to a patient's heart determines if a T wave alternan pattern of the patient's heart exists. The device includes a sensing circuit that generates an electrical signal including T waves representing paced electrical activity of the heart and a morphology detector that measures a metric of each T wave in the electrical signal. A T wave alternan pattern detector determines, responsive to the measured T wave metrics, if a paced activity T wave alternan pattern is present. The T wave alternan pattern detector may also detect for intrinsic T wave alternan patterns. A therapy control initiates suitable different responses for a paced T wave alternan pattern detection and an intrinsic T wave alternan pattern detection.

 
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