T-Wave Alternans Preceding Torsade de Pointes Ventricular Tachycardia
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 β-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.
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.
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.
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