Prevalence of Microvolt T-Wave Alternans in Patients With Long QT Syndrome and Its Association With Torsade de Pointes

Circulation. Arrhythmia and Electrophysiology
Nobuhiro TakasugiShinya Minatoguchi

Abstract

Prevalence of microvolt T-wave alternans (TWA) and the strength of its association with torsade de pointes (TdP) history have not been fully investigated in patients with long QT syndrome (LQTS). Twenty-four-hour continuous 12-lead ECGs were recorded in 10 healthy subjects (5 men; median age, 21.5 years) and 32 patients (13 men; median age, 13 years) with LQTS types 1 (n=18), 2 (n=4), 3 (n=4), and unidentified (n=6). Peak TWA was determined by the Modified Moving Average method. None of the healthy subjects had TWA ≥42 µV. All 8 (100%) LQTS patients with a history of TdP exhibited TWA ≥42 µV, whereas only 14 (58.3%) of the 24 LQTS patients without TdP history reached ≥42 µV (p=0.04). Thus, the 42-µV cut point provided 100% sensitivity and 41.7% specificity for an association with TdP history. In the 22 (68.8%) LQTS patients with TWA ≥42 µV, only 2 (median; interquartile range, 1-3) leads exhibited TWA ≥42 µV. Highest TWA levels were recorded in precordial leads (V1-V6) in 30 (93.8%) patients, most frequently in lead V2 (43.8%). A single ECG lead detected only ≤63.6% of TWA ≥42 µV episodes, whereas the combined leads V2 to V5 detected 100% of TWA ≥42 µV. Microvolt TWA is far more prevalent in LQTS patients than previously report...Continue Reading

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Citations

Feb 4, 2016·Circulation. Arrhythmia and Electrophysiology·Andrew M Davis
May 23, 2019·Arrhythmia & Electrophysiology Review·Nabil El-SherifMohamed Boutjdir
Jul 1, 2020·Cardiology in the Young·Liu Hsin-MingChiu Shuenn-Nan
Jan 1, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Joanna LewekIwona Cygankiewicz
Dec 20, 2017·Journal of Arrhythmia·Yukiko Nakano, Shimizu Wataru
Feb 7, 2018·Pacing and Clinical Electrophysiology : PACE·Nabil El-SherifMohamed Boutjdir
Feb 8, 2019·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Nobuhiro TakasugiRichard L Verrier
Jun 27, 2019·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Nobuhiro TakasugiRichard L Verrier
Nov 28, 2017·Cardiac Electrophysiology Clinics·Andrés Ricardo Pérez-RieraMohammad Shenasa

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