Images in cardiovascular medicine. Concomitant T-wave alternans and pulsus alternans in a child with long-QT syndrome.

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HomeCirculationVol. 108, No. 6Concomitant T-Wave Alternans and Pulsus Alternans in a Child With Long-QT Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBConcomitant T-Wave Alternans and Pulsus Alternans in a Child With Long-QT Syndrome Bert Suys, MD, Rudi De Paep, MD, Katrien François, MD and Daniel De Wolf, MD, PhD Bert SuysBert Suys From the Departments of Pediatric Cardiology (B.S., D.D.W.), Intensive Care (R.D.P.), and Cardiac Surgery (K.F.), University Hospitals, Antwerp and Ghent, Belgium. Search for more papers by this author , Rudi De PaepRudi De Paep From the Departments of Pediatric Cardiology (B.S., D.D.W.), Intensive Care (R.D.P.), and Cardiac Surgery (K.F.), University Hospitals, Antwerp and Ghent, Belgium. Search for more papers by this author , Katrien FrançoisKatrien François From the Departments of Pediatric Cardiology (B.S., D.D.W.), Intensive Care (R.D.P.), and Cardiac Surgery (K.F.), University Hospitals, Antwerp and Ghent, Belgium. Search for more papers by this author and Daniel De WolfDaniel De Wolf From the Departments of Pediatric Cardiology (B.S., D.D.W.), Intensive Care (R.D.P.), and Cardiac Surgery (K.F.), University Hospitals, Antwerp and Ghent, Belgium. Search for more papers by this author Originally published12 Aug 2003https://doi.org/10.1161/01.CIR.0000079312.63225.AECirculation. 2003;108:e36A13-month-old girl was hospitalized for cardiogenic shock and convulsions after a few days of fever and malaise. She was known to have long-QT syndrome and titers for adenovirus. Her myocardial function was poor, and myocarditis was suspected. ECG monitoring showed extremely long QT and QTc with T-wave alternans. A simultaneous arterial pressure curve showed pulsus alternans (Figure 1). The occurrence of concomitant electrical alternans and mechanical alternans is extremely rare; the former is related to action potential duration changes and is a marker for electrical instability, and the latter is explained by hemodynamic alterations. Gradually, a pseudo 2:1 AV block developed (extreme prolongation of ventricular refractoriness), with bradycardia and hypotension (Figure 2). After 10 days of ventilation and massive inotropic support, she was extubated and recovered slowly. Before leaving the hospital, the patient had a pacemaker-defibrillator with epipericardial patch surgically implanted (Figure 3), and β-blockade reinstalled. Download figureDownload PowerPointFigure 1. Prolonged QT and QTc intervals, T wave alternans, and pulsus alternans.Download figureDownload PowerPointFigure 2. Pseudo 2:1 AV block with hypotension.Download figureDownload PowerPointFigure 3. Chest x-ray study showing pacemaker–internal cardioverter-defibrillator with epipericardial patch; the battery was implanted in the perirenal space.FootnotesCorrespondence to Bert E. Suys, Congenital and Pediatric Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Deogire A and Hamde S (2015) A collaborative approach to improve TWA detection 2015 International Conference on Industrial Instrumentation and Control (ICIC), 10.1109/IIC.2015.7150747, 978-1-4799-7165-7, (247-251) Xie Y, Hu G, Sato D, Weiss J, Garfinkel A and Qu Z (2007) Dispersion of Refractoriness and Induction of Reentry due to Chaos Synchronization in a Model of Cardiac Tissue, Physical Review Letters, 10.1103/PhysRevLett.99.118101, 99:11 Lansky A, Costa R, Mintz G, Tsuchiya Y, Midei M, Cox D, O’Shaughnessy C, Applegate R, Cannon L, Mooney M, Farah A, Tannenbaum M, Yakubov S, Kereiakes D, Wong S, Kaplan B, Cristea E, Stone G, Leon M, Knopf W and O’Neill W (2004) Non–Polymer-Based Paclitaxel-Coated Coronary Stents for the Treatment of Patients With De Novo Coronary Lesions, Circulation, 109:16, (1948-1954), Online publication date: 27-Apr-2004. August 12, 2003Vol 108, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000079312.63225.AEPMID: 12912796 Originally publishedAugust 12, 2003 PDF download Advertisement