(Circulation. 2000;101:2550.)
© 2000 American Heart Association, Inc.
Images in Cardiovascular Medicine |
T-Wave Alternans Preceding Torsade de Pointes Ventricular Tachycardia
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.
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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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