T Wave Alternans: Causes & Reasons

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Possible Causes for T Wave Alternans

Torsades De Pointes

U wave was observed in 86 episodes (56.9%), among that in 69 episodes, the U/T wave ratio was > 1. Macro T wave alternans was observed in 4 patients. [ncbi.nlm.nih.gov]

reversed asymmetry (20.0% vs 0%, P = .001), and T-wave alternans (35.0% vs 0%, P = .001). [ncbi.nlm.nih.gov]

T-wave alternans and sinus pause corroborates this further. [ecgwaves.com]

Long QT Syndrome

[…] case with type 3 congenital long QT syndrome, who exhibited a sudden paradoxical QT-interval prolongation during a progressive increase in heart rate, which exacerbated T-wave [ncbi.nlm.nih.gov]

U wave was observed in 86 episodes (56.9%), among that in 69 episodes, the U/T wave ratio was > 1. Macro T wave alternans was observed in 4 patients. [ncbi.nlm.nih.gov]

alternans in polarity or amplitude ( Figure 1 ), when observed, is diagnostic as we proposed ≈40 years ago. 31 T-wave alternans is a marker of major electric instability [circep.ahajournals.org]

Long QT Syndrome 14

[…] individual. 5/14 patients with LQTS had pathological findings during ambulatory ECG monitoring (2 patients with episodes of torsade de pointes tachycardia, 2 patients with T-wave [karger.com]

Follow-up electrocardiograms and Holter records show persistent QT prolongation, bizarre T waves, and intermittent episodes of T wave alternans. [link.springer.com]

[…] morphological abnormalities and T-wave alternans ( Figure 1 ). [circ.ahajournals.org]

Nonsustained Ventricular Tachycardia

We examined whether T-wave alternans (TWA) level is correlated with nonsustained ventricular tachycardia (NSVT) incidence in association with PCI in patients with acute ST-segment [ncbi.nlm.nih.gov]

OBJECTIVE: Microvolt T-wave Alternans (TWA) is associated with abnormal repolarization and predicts arrhythmic mortality in patients with previous myocardial infarction (MI [ncbi.nlm.nih.gov]

Alternans T-wave alternans (TWA) is a test that is thought to reflect dispersion of repolarization and has been shown to predict VT inducibility and future arrhythmic events [clinicalgate.com]

Ventricular Fibrillation

RESULTS: Frequencies of history of syncope and spontaneous type 1 ECG, r-J interval in V1, QRS duration in V6, and LAS40, Tpeak-Tend dispersion, and max T-wave alternans were [ncbi.nlm.nih.gov]

In this type of test, slight changes in your electrocardiogram’s T wave are monitored during gentle exercise. [healthline.com]

wave alternans 1 Notched T waves in three leads 1 Low heart rate for age (resting rate below second percentile 0.5 Clinical History Syncope With stress 2 Without stress 1 [emedicine.medscape.com]

Ventricular Tachycardia

Like T-wave alternans, the test is not widely used, with the exception of longitudinal evaluation of patients with suspected ARVC. [emedicine.com]

Chow T, Kereiakes DJ, Bartone C, et al. Prognostic utility of microvolt T-wave alternans in risk stratification of patients with ischemic cardiomyopathy. [ncbi.nlm.nih.gov]

Signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans were not helpful for arrhythmia risk stratification. [academic.oup.com]

Ventricular Arrhythmia

T wave alternans in idiopathic long QT syndrome. J Am Coll Cardiol. 1994;23(7):1541–6. PubMed CrossRef Google Scholar 50. Napolitano C, Priori SG, Schwartz PJ. [doi.org]

[…] morphology, 8 9 T-wave alternans, 10 an abnormal slope of the relation of QT interval to cycle length (QT/RR interval slope), 11 12 13 and an abnormal QRST isoarea distribution [doi.org]

[…] systolic blood pressure rises above 200 mm Hg, there is an increase in premature ventricular contractions or nonsustained ventricular tachycardia or polymorphic VT occurs, T-wave [doi.org]

Paroxysmal Ventricular Tachycardia

Ambulatory (Holter) ECG: An ambulatory ECG can be necessary if the diagnosis needs to be clarified, by detecting arrhythmias, QT-interval changes, T-wave alternans (TWA) or [textbookofcardiology.org]

Torsade-De-Pointes Syndrome with Short Coupling Interval

E-mail: Alizadeh_73/at/yahoo.com Abstract This report presents a patient with macrovolt T wave alternans, PVC with R on T or a long-short sequence followed by torsades de [ipej.org]

Fig. 2 (a) illustrates a gradual increase in the sinus rate with T-wave alternans resulting in TdP. [academic.oup.com]

July 2010: Revista Española de Cardiología # 19 Amir Tavoosi, Abolfath Alizadeh, Mazdak Khalili, Zahra Emkanjoo This report presents a patient with macrovolt T wave alternans [readbyqxmd.com]

Long QT Syndrome 5

alternans in polarity or amplitude (Figure 1), when observed, is diagnostic as we proposed ≈40 years ago.31 T-wave alternans is a marker of major electric instability and [ahajournals.org]

alternans 1 point Notched T-waves in at least 3 leads 1 point Low heart rate for age (children) 0.5 points Syncope with stress 2 points Cannot receive points both for syncope [en.wikipedia.org]

The morphology of the T wave is often useful for the diagnosis, and the precordial leads are especially informative when they reveal biphasic or notched T waves.30 T-wave [ahajournals.org]

Long QT Syndrome 10

T-wave alternans and sinus pause corroborates this further. [ecgwaves.com]

wave alternans - 1 point Notched T wave in at least 3 leads - 1 point Low heart rate for age (children) - 0.5 points Syncope (one cannot receive points both for syncope and [checkorphan.org]

waves which is typical for LQT2 [11] (fig. 1A) and the occasional appearance of T wave alternans [3] (fig. 1B). [smw.ch]

Long QT Syndrome 12

After the patient returned to ICU, the ECG showed QT prolongation with large U waves and T-wave alternans. [ci.nii.ac.jp]

Long QT Syndrome 13

alternans [1 point] Notched T wave in 3 leads [1 point] Low heart rate for age [0.5 point] Clinical history Syncope [2 points] With stress [1 point] Without stress [1 point [athletesheart.org]

T-wave alternans and sinus pause corroborates this further. [ecgwaves.com]

waves which is typical for LQT2 [11] (fig. 1A) and the occasional appearance of T wave alternans [3] (fig. 1B). [smw.ch]

Long QT Syndrome 6

Macroscopic T wave alternans in long QT syndrome. Indian J Pediatr. 2006;73:539–40. PubMed CrossRef 14. Abass FA, Shahi M, Kumar N, Bhargava M, Gupta S, Puliyel JM. [springermedizin.de]

The severity of T-wave alternans tends to correlate with the risk of cardiac events. 10 View/Print Figure FIGURE 3. Electrocardiogram showing torsades de pointes. [aafp.org]

Aborted cardiac arrest Family history of unexplained sudden death Syncope Torsade de pointes T-wave alternans Prolonged QTc 21. [de.slideshare.net]

Barth Syndrome

Evaluation included echocardiography, electrocardiography (standard and signal-averaged), microvolt T wave alternans analysis, biochemical and hematologic laboratory analyses [ncbi.nlm.nih.gov]

Long QT Syndrome 3

alternans 1 point Notched T-waves in at least 3 leads 1 point Low heart rate for age (children) 0.5 points Syncope with stress 2 points Cannot receive points both for syncope [en.wikipedia.org]

Corrected QT interval (QTc) ≥ 480 ms 3 points QTc defined according to Bazett's correction 460-470 ms 2 points 450 ms and male gender 1 point Torsades de pointes 2 points T-wave [en.wikipedia.org]

Long QT Syndrome 1

alternans 1 point Notched T-waves in at least 3 leads 1 point Low heart rate for age (children) 0.5 points Syncope with stress 2 points Cannot receive points both for syncope [en.wikipedia.org]

Long QT Syndrome 8

The severity of T-wave alternans tends to correlate with the risk of cardiac events. 10 View/Print Figure FIGURE 3. Electrocardiogram showing torsades de pointes. [aafp.org]

Macroscopic T-wave alternans: Positive and negative T waves on a beat-to-beat basis. [ncbi.nlm.nih.gov]

[…] patterns, as described in Table 1, may point to LQT1 or LQT3 variants. 6 Overt T-wave alternans–grossly visible beat-to-beat variation in T-wave amplitude and/or polarity–is [nature.com]

Brugada Syndrome

wave alternans and brugada syndrome also be simulated and researched, which validated this ecg model, at the same time be beneficial to further research on 文中除了仿真正常生理状态下的心电图以外 [ichacha.net]

T‐wave alternans in patients with Brugada syndrome T‐wave alternans is the ECG manifestation of action potential repolarization alternans. [intechopen.com]

The relationship between the magnitude of T wave alternans and amplitude of the corresponding T wave in patients with Brugada syndrome. [revespcardiol.org]

Familial Ventricular Polymorphic Tachycardia

The long QT syndrome is characterized by increased QT interval duration and the presence of T-wave alternans- an indicator for increased risk of cardiac arrhythmias. [symptoma.com]

T wave alternans（英语：T wave alternans） ST Osborn wave（英语：Osborn wave） ST elevation（英语：ST elevation） ST depression（英语：ST depression） Strain pattern（英语：Strain pattern）心肥大（英语 [zh.wikipedia.org]

T wave may be notched- often in long QT 2 syndrome (LQT2) or have a wide base- especially in LQT1. [symptoma.com]

Short QT Syndrome Type 1

T-wave alternans and sinus pause corroborates this further. [ecgwaves.com]

Microvolt T-wave alternans in short QT syndrome. Pacing Clin Electrophysiol. 2012 Dec;35(12):1413-9. 24. [babymhospital.org]

Eleclazine, an inhibitor of the cardiac late sodium current, is superior to flecainide in suppressing catecholamine-induced ventricular tachycardia and T-wave alternans in [itaca.edu.es]

Catecholaminergic Polymorphic Ventricular Tachycardia Type 2

Eloff -- Diagnostic Electrocardiography / Preben Bjerregaard -- Microvolt T Wave Alternans: Mechanisms and Implications for Prediction of Sudden Cardiac Death / Florian Rader [worldcat.org]

Mean T-wave alternans (TWA) was 25 ± 1.4 µV in CPVT patients vs. 31 ± 2.0 µV in controls (P < 0.05). [ncbi.nlm.nih.gov]

Wave Alternans: Mechanisms and Implications for Prediction of Sudden Cardiac Death -- Heart Rate Variability: Measurements and Risk Stratification -- Orthostatic Challenge [worldcat.org]

Athletic Heart Syndrome

Dan Sheng and Xianglin Cheng, Analysis of the Q-T Dispersion and T Wave Alternans in Patients with Epilepsy, Yangtze Medicine, 01, 02, (109), (2017). Karen M. [dx.doi.org]

Xian Li and Xianglin Cheng, Application of T-Wave Alternans in Evaluation of Prognosis in Patients with Intracerebral Hemorrhage, Yangtze Medicine, 01, 03, (127), (2017). [dx.doi.org]

Incessant Infant Ventricular Tachycardia

Like T-wave alternans, the test is not widely used, with the exception of longitudinal evaluation of patients with suspected ARVC. [emedicine.medscape.com]

Microvolt T-wave alternans: there is evidence to suggest that it might be helpful as a negative predictor in patients with ischemic heart disease, who might be at risk for [clinicaladvisor.com]

In the pediatric population, although T-wave alternans do seem to be associated with serious VAs, other variables offer more information. [emedicine.medscape.com]

3-Methylglutaconic Aciduria Type 5

View abstract Microvolt t-wave alternans with exercise in pediatrics and congenital heart disease: limitations and predictive value. [childrenshospital.org]

Paroxysmal Ventricular Fibrillation Type 1

T‐wave alternans in patients with Brugada syndrome T‐wave alternans is the ECG manifestation of action potential repolarization alternans. [intechopen.com]

The severity of T-wave alternans tends to correlate with the risk of cardiac events. 10 View/Print Figure FIGURE 3. Electrocardiogram showing torsades de pointes. [aafp.org]

Diagnostic Evaluation 69 T-Wave Alternans Part X. [euro-libris.ro]

Familial Progressive Cardiac Conduction Defect Type 2

Wave Alternans Mechanisms and Implications for Prediction of Sudden Cardiac Death 394 Invasive Electrophysiologic Testing Role in Sudden Death Prediction 409 Provocative Testing [books.google.com]

Parameters such as T-wave alternans (beat-to-beat alternation in the shape, amplitude, or timing of the ST segment and the T wave) ≥ 60μV during exercise, heart rate recovery [escardio.org]

Appearance of the following should raise a red flag: Accentuation of coved-type (type I) ST elevation Beat-by-beat T wave alternans Short-coupled spontaneous PVC arising from [thecardiologyadvisor.com]

Cardiac Arrhythmia

Diagnostic Tools EKG/ECG Holter/Event Monitor Tilt Table Test Electrophysiology (EP) Study T Wave Alternans Genetic testing Echocardiogram CT Scan Cardiovascular MRI PET Scan [medstarunionmemorial.org]

Diagnostic Tools ECG Holter/Event Monitor Tilt Table Test Electrophysiology (EP) Study T Wave Alternans Genetic testing Echocardiogram CT Scan Cardiovascular MRI PET Scan [medstarheartinstitute.org]

Fig. 2 (a) illustrates a gradual increase in the sinus rate with T-wave alternans resulting in TdP. [dx.doi.org]

Jervell-Lange-Nielsen Syndrome

wave alternans or long pauses followed by abnormal T waves) despite β -blockade and LCSD, and d) sustained ventricular arrhythmias, or sudden cardiac arrest (secondary prevention [itaca.edu.es]

His ECG revealed a markedly prolonged QTc interval of 530 ms (corrected by Bazett’s formula) and T-wave alternans on V1 to V4 (Fig. 2 ). [jmedicalcasereports.biomedcentral.com]

alternans 1 - Notched T wave in 3 leads 1 - Low heart rate for age 0.5 Clinical history - Syncope With stress 2 Without stress 1 - Congenital deafness 0.5 Family history [itaca.edu.es]

Paroxysmal Ventricular Fibrillation

The following risk stratifiers were assessed: late potentials (LPs; depolarization abnormality marker) for 24 hours using a newly developed signal-averaging system, and T-wave [ncbi.nlm.nih.gov]

Diagnostic Evaluation 69 T-Wave Alternans Part X. [euro-libris.ro]

alternans and QT dispersion (repolarization abnormality markers). [ncbi.nlm.nih.gov]