T-wave morphology after epinephrine bolus may reveal silent long QT syndrome mutation carriers

Journal of Electrocardiology
Anna-Mari HekkalaToivonen Lauri

Abstract

Long QT syndrome (LQTS) gene mutation carriers with indeterminate electrocardiogram frequently escape clinical diagnosis. We assessed the use of epinephrine bolus injection in revealing T-wave abnormalities. We recruited 30 genotyped asymptomatic LQTS gene carriers with nondiagnostic QT interval and 15 controls. Electrocardiogram was recorded with body surface potential mapping after an intravenous epinephrine bolus. T-wave morphology was determined as normal, biphasic, inverted, bifid, or combined pattern. Long QT syndrome carriers and healthy controls had different T-wave profiles (P = .027). Of controls, 12 (80%) of 15 had no change or biphasic appearance, whereas only 10 (33%) of 30 of LQTS carriers had so. Bifid or combined pattern occurred in 15 (50%) of 30 in LQTS and in 6 (60%) of 10 in the LQT3 subgroup but only in 1 (7%) of 15 of healthy. Modification of ventricular repolarization with low-dose epinephrine injection helps to distinguish silent LQTS mutation carriers. This concerns also the LQT3 subtype, which may escape tests.

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Citations

Jul 5, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Ehud ChorinRaphael Rosso
Jul 25, 2013·Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc·Shlomo Stern
Feb 28, 2016·Pediatric Cardiology·Kazuhiro TakahashiHitoshi Ganaha
May 26, 2020·Pediatrics International : Official Journal of the Japan Pediatric Society·Kazuhiro TakahashiMami Nakayashiro

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