Possible Causes for Late Onset T-Wave Long QT Syndrome 10 T wave LQTS 3 5-10% SCN5A Prolonged Na + influx Biphasic or peaked, late-onset, T wave LQTS 4 1-2% ANKB Build-up of Na + within cell and Ca 2+ outside of cell Variable Qt [geneticheartdisease.org] ' broad based T wave LQT2 small late T wave LQT3 prolonged QT interval with 'late onset' T wave with a normal configuration In congenital LQTS the ventricular repolarisation [en.ecgpedia.org] The electrocardiogram of patients with LQT1 most often has as a broad-based T-wave or a late-onset normal appearing T-wave 7, 3 (Figure 2). [geneticheartdisease.org] Long QT Syndrome 6 ' broad based T wave LQT2 small late T wave LQT3 prolonged QT interval with 'late onset' T wave with a normal configuration In congenital LQTS the ventricular repolarisation [en.ecgpedia.org] The electrocardiogram of patients with LQT1 most often has as a broad-based T-wave or a late-onset normal appearing T-wave 7, 3 (Figure 2). [geneticheartdisease.org] especially nightly noise JLN2 if homozygous, LQTS2 if heterozygous 152427 LQTS3 3p21 SCN5A NA channel 5-10% 0.56%/year AD 'Late onset' T wave with normal configuration 600163 [en.ecgpedia.org] Long QT Syndrome 13 ' broad based T wave LQT2 small late T wave LQT3 prolonged QT interval with 'late onset' T wave with a normal configuration In congenital LQTS the ventricular repolarisation [en.ecgpedia.org] especially nightly noise JLN2 if homozygous, LQTS2 if heterozygous 152427 LQTS3 3p21 SCN5A NA channel 5-10% 0.56%/year AD 'Late onset' T wave with normal configuration 600163 [en.ecgpedia.org] ' T wave exercise, especially swimming JLN1 if homozygous, LQTS1 if heterozygous 607542 LQTS2 7q35 KCNH2 hERG I kr 30-40% 0.60%/year AD small late T wave adrenergic triggers [en.ecgpedia.org] Long QT Syndrome ' broad based T wave LQT2 small late T wave LQT3 prolonged QT interval with 'late onset' T wave with a normal configuration In congenital LQTS the ventricular repolarisation [en.ecgpedia.org] especially nightly noise JLN2 if homozygous, LQTS2 if heterozygous 152427 LQTS3 3p21 SCN5A NA channel 5-10% 0.56%/year AD 'Late onset' T wave with normal configuration 600163 [en.ecgpedia.org] ' T wave exercise, especially swimming JLN1 if homozygous, LQTS1 if heterozygous 607542 LQTS2 7q35 KCNH2 hERG I kr 30-40% 0.60%/year AD small late T wave adrenergic triggers [en.ecgpedia.org] Long QT Syndrome 14 C ) LQTS type 3 with late-onset peaked T wave. [jstage.jst.go.jp] ECGs of LQTS types 1–3, with the typical T wave of each subtype. ( A ) LQTS type 1 with typical broad-based T wave pattern. ( B ) LQTS type 2 with typical bifid T wave. [jstage.jst.go.jp] Anthracycline-Induced Cardiomyopathy Late-onset arrhythmia and sudden cardiac death can occur even 15 years after anthracycline administration has been ceased. [symptoma.com] It may reveal abnormalities in 20- 30% of patients, including nonspecific ST and T wave changes and decreased QRS voltage in cases with associated pericarditis, QT interval [symptoma.com] Catecholaminergic Polymorphic Ventricular Tachycardia The LQT1 group usually has a broad and pronounced T-wave or late onset of a normal-appearing T-wave. The prevalence of congenital LQTS is around 1:2,000 to 1:5,000 LQTS. [radcliffecardiology.com] Also, abnormalities in T-wave amplitude and duration can help to distinguish among LQT1, LQT2, and LQT3. [radcliffecardiology.com] WT Syndrome The electrocardiogram of patients with LQT1 most often has as a broad-based T-wave or a late-onset normal appearing T-wave 7, 3 (Figure 2). [geneticheartdisease.org] low-amplitude, T wave LQTS 3 5-10% SCN5A Prolonged Na + influx Biphasic or peaked, late-onset, T wave LQTS 4 1-2% ANKB Build-up of Na + within cell and Ca 2+ outside of [geneticheartdisease.org] The electrocardiogram for these patients will often have late-onset of the T-wave that can be biphasic or peaked 7, 3 (Figure 2) LQT4: The genetic mutation in this subtype [geneticheartdisease.org] Jervell-Lange-Nielsen Syndrome Type 2 […] broad based T wave Small late T wave Late onset T wave with normal configuration Arrhythmogenic triggers Exercise, especially swimming Adrenergic triggers, especially nightly [textbookofcardiology.org] […] characteristic clinical features and ECG abnormalities LQTS type LQTS 1 LQTS 2 LQTS 3 Gene/current KCNQ1/IK s KCNH2/IK r SCN5A/INa B-blokker efficacy ++++ +++ ++ ECG Early onset [textbookofcardiology.org] Familial Pericarditis PR segment deviation with opposite polarity to the P wave. - Early-onset stage II: reversal of changes in the ST segment, PR segment diverted. - Late-onset stage II: progressive [scielo.br] […] flattening and T wave inversion. - Stage III: generalized T wave inversion. - Stage IV: electrocardiogram returns to baseline rate. [scielo.br] Cardiac Dyskinesia Depolarization/conduction abnormalities Major Minor Epsilon wave (reproducible low-amplitude signals between end of QRS complex to onset of the T wave) in the right precordial [en.ecgpedia.org] […] leads (V 1 to V 3 ) Late potentials by SAECG in ≥1 of 3 parameters in the absence of a QRS duration of ≥110 ms on the standard ECG Filtered QRS duration (fQRS) ≥114 ms Duration [en.ecgpedia.org] Pericarditis PR segment deviation with opposite polarity to the P wave. - Early-onset stage II: reversal of changes in the ST segment, PR segment diverted. - Late-onset stage II: progressive [scielo.br] […] flattening and T wave inversion. - Stage III: generalized T wave inversion. - Stage IV: electrocardiogram returns to baseline rate. [scielo.br] Arrhythmogenic Right Ventricular Dysplasia Depolarization/conduction abnormalities Major Minor Epsilon wave (reproducible low-amplitude signals between end of QRS complex to onset of the T wave) in the right precordial [en.ecgpedia.org] T WAVE ABNORMALITIES, EPSILON WAVES SAECG NORMAL LATE POTENTIALS ECHO NORMAL WALL MOTION ABNORMALITY OR DILATATION OF RV ARRHYTHMIAS REPETATIVE MONOMORPHIC VT SVT,NSVT,VF [slideshare.net] […] leads (V 1 to V 3 ) Late potentials by SAECG in ≥1 of 3 parameters in the absence of a QRS duration of ≥110 ms on the standard ECG Filtered QRS duration (fQRS) ≥114 ms Duration [en.ecgpedia.org] Secondary Cardiomyopathy Depolarization/conduction abnormalities Major Epsilon wave (reproducible low-amplitude signals between end of QRS complex to onset of the T wave) in the right precordial leads [textbookofcardiology.org] (V 1 to V 3 ) Minor Late potentials by SAECG in =1 of 3 parameters in the absence of a QRS duration of =110 ms on the standard ECG Filtered QRS duration (fQRS) =114 ms Duration [textbookofcardiology.org] Myocarditis Click to view larger Download figure as PowerPoint slide Fig. 4.1.3.1 (a) Typical signs for myocardial injury with inferolateral T waves. [oxfordmedicine.com] (b) Typical CMR of lateral myocarditis with subendocardial late enhancement. [oxfordmedicine.com] New onset of ventricular arrhythmias at rest or during exercise in athletes should suggest a work-up for acute myocarditis. [oxfordmedicine.com] Infiltrative Cardiomyopathy Depolarization/conduction abnormalities Major Epsilon wave (reproducible low-amplitude signals between end of QRS complex to onset of the T wave) in the right precordial leads [textbookofcardiology.org] (V 1 to V 3 ) Minor Late potentials by SAECG in =1 of 3 parameters in the absence of a QRS duration of =110 ms on the standard ECG Filtered QRS duration (fQRS) =114 ms Duration [textbookofcardiology.org] Lennox-Gastaut Syndrome Bauer G, Aichner F, Saltuari L - Epilepsies with diffuse slow spikes and waves of late onset. Eur Neurol 22:344, 1983. [ Links ] 3. [scielo.br] Bauer G, Benke T, Bohr K - The Lennox-Gastaut syndrome in adulthood. In Nieder-meyer E, Degen R (eds): The Lenox-Gastaut Syndrome. [scielo.br] Hemochromatosis-Related Cardiomyopathy Depolarization/conduction abnormalities Major Epsilon wave (reproducible low-amplitude signals between end of QRS complex to onset of the T wave) in the right precordial leads [textbookofcardiology.org] (V 1 to V 3 ) Minor Late potentials by SAECG in =1 of 3 parameters in the absence of a QRS duration of =110 ms on the standard ECG Filtered QRS duration (fQRS) =114 ms Duration [textbookofcardiology.org] Antipsychotic Agent Papazizis G, Tzellos T, Tahmatzidis D, Doliantis K, Kouvelas D. Late-onset clozapine-induced hypothermia accompanied by electrocardiogram Osborn waves. [doi.org]