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(Circulation. 2000;101:2550.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

T-Wave Alternans Preceding Torsade de Pointes Ventricular Tachycardia

Antonis A. Armoundas, PhD; Toshihiko Nanke, MD; Richard J. Cohen MD, PhD

From the Harvard University–Massachusetts Institute of Technology Division of Health Sciences and Technology (A.A.A., R.J.C.), Boston, Mass, and the 2nd Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan (T.N.).

A 72-year-old Japanese woman without known structural heart disease presented for evaluation of multiple syncopal episodes. While waiting for evaluation in the hospital outpatient waiting room, the patient had a cardiac arrest. She was successfully resuscitated. Subsequently, a 12-lead ECG revealed a prolonged QT interval of 0.70 seconds and sinus bradycardia. A diagnosis of idiopathic long-QT syndrome was made. Holter monitoring was also performed. The patient had a pacemaker implanted (implantable cardioverter-defibrillator therapy was not available) and was discharged on ß-blocker therapy. She died suddenly 4 months later. Panel A of the Figure shows 2 minutes of the ECG recorded on a Holter monitor, which reveals prominent T-wave alternans preceding the onset of torsade de pointes ventricular tachycardia that persisted for >1 minute. After the termination of the tachycardia, T-wave alternans persists. Panel B of the Figure shows 3 minutes of the ECG obtained 2 minutes later, which reveals persistent T-wave alternans and several episodes of nonsustained ventricular tachycardia.

View larger version (40K): [in this window] [in a new window]   Figure 1.

Acknowledgments

This study was supported by grants from the National Aeronautics and Space Administration through the National Space Biomedical Research Institute and NASA grant NAG5-4989.

Footnotes

Reprint requests to Richard J. Cohen, Massachusetts Institute of Technology, E25–335a, 77 Massachusetts Ave, Cambridge, MA 02139.

Dr Cohen is affiliated (consultant, director, and equity holder) with Cambridge Heart, Inc, a manufacturer of equipment for the measurement of microvolt-level T-wave alternans. No product of the company was used in the conduct of the study reported here, nor did the company provide any financial support for this study.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Armoundas, A. A. Articles by MD, R. J. C. Search for Related Content PubMed PubMed Citation Articles by Armoundas, A. A. Articles by MD, R. J. C. Related Collections Electrophysiology Clinical genetics Arrhythmias, clinical electrophysiology, drugs