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T-wave alternans

MedGen UID:
745313
Concept ID:
C1998313
Finding
Synonyms: T wave alternans; T Wave Alternans; T Wave Alternans by ECG Finding; T Wave Alternans by EKG Finding
SNOMED CT: T wave alternans (428550008)
 
HPO: HP:0012266

Definition

A periodic beat-to-beat variation in the amplitude or shape of the T wave in an EKG. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVT-wave alternans

Conditions with this feature

Long QT syndrome 10
MedGen UID:
394836
Concept ID:
C2678484
Disease or Syndrome
Any long QT syndrome in which the cause of the disease is a mutation in the SCN4B gene.
Long QT syndrome 14
MedGen UID:
864108
Concept ID:
C4015671
Disease or Syndrome
LQT14 is a cardiac arrhythmia disorder characterized by ventricular arrhythmias, often life-threatening, occurring very early in life, frequent episodes of T-wave alternans, markedly prolonged QTc intervals, and intermittent 2:1 atrioventricular block (Crotti et al., 2013). Patients with LQT14, LQT15 (616249), or LQT16 (618782), resulting from mutation in calmodulin genes CALM1, CALM2 (114182), or CALM3 (114183), respectively, typically have a more severe phenotype, with earlier onset, profound QT prolongation, and a high predilection for cardiac arrest and sudden death, than patients with mutations in other genes (Boczek et al., 2016).
Long QT syndrome 16
MedGen UID:
1713991
Concept ID:
C5394068
Disease or Syndrome
LQT16 Long QT syndrome-16 (LQT16) is characterized by a markedly prolonged corrected QT (QTc) interval and 2:1 atrioventricular (AV) block, with onset in the perinatal period. Patients experience bradycardia or ventricular tachyarrhythmias that may result in syncope, cardiac arrest, and/or sudden death (Reed et al., 2015; Wren et al., 2019). Patients with LQT14 (616247), LQT15 (616249), or LQT16, resulting from mutation in calmodulin genes CALM1 (114180), CALM2 (114182), or CALM3, respectively, typically have a more severe phenotype, with earlier onset, profound QT prolongation, and a high predilection for cardiac arrest and sudden death, than patients with mutations in other genes (Boczek et al., 2016). CPVT6 Catecholaminergic polymorphic ventricular tachycardia-6 (CPVT6) is characterized by childhood-onset syncopal episodes with exercise or stress. Electrocardiogram (ECG) shows a normal QT interval with a prominent U wave, and stress testing reveals premature ventricular contractions (PVCs) that may occur as bigeminy or couplets, and nonsustained ventricular tachycardia (Gomez-Hurtado et al., 2016).

Professional guidelines

PubMed

Quan XQ, Zhou HL, Ruan L, Lv JG, Yao JH, Yao F, Huang K, Zhang CT
BMC Cardiovasc Disord 2014 Dec 20;14:198. doi: 10.1186/1471-2261-14-198. PMID: 25528490Free PMC Article
Verrier RL
Anadolu Kardiyol Derg 2014 Feb;14(1):96. Epub 2013 Dec 18 doi: 10.5152/akd.2013.201315. PMID: 24382500
Yalın K, Gölcük E, Teker E, Bilge AK, Adalet K
Anadolu Kardiyol Derg 2013 Nov;13(7):702-4. Epub 2013 Sep 26 doi: 10.5152/akd.2013.228. PMID: 24084148

Recent clinical studies

Etiology

de Oliveira Antunes M, Samesima N, Pereira Filho HG, Matsumoto AY, Verrier RL, Pastore CA, Arteaga-Fernández E, Mady C
J Electrocardiol 2017 Mar-Apr;50(2):184-190. Epub 2016 Oct 28 doi: 10.1016/j.jelectrocard.2016.10.010. PMID: 27916321
Cygankiewicz I
Prog Cardiovasc Dis 2013 Sep-Oct;56(2):160-71. Epub 2013 Aug 29 doi: 10.1016/j.pcad.2013.08.002. PMID: 24215748
Myles RC, Jackson CE, Tsorlalis I, Petrie MC, McMurray JJ, Cobbe SM
Circulation 2007 Dec 18;116(25):2984-91. doi: 10.1161/CIRCULATIONAHA.107.699918. PMID: 18086940
El-Sherif N, Turitto G
Curr Opin Cardiol 2003 Jan;18(1):6-13. doi: 10.1097/00001573-200301000-00002. PMID: 12496496
Bloomfield DM, Hohnloser SH, Cohen RJ
J Cardiovasc Electrophysiol 2002 May;13(5):502-12. doi: 10.1046/j.1540-8167.2002.00502.x. PMID: 12030535

Diagnosis

Wei Z, Xu F, Zhao YT
QJM 2024 Mar 27;117(3):216-217. doi: 10.1093/qjmed/hcad260. PMID: 37982757
Feng HW, Zhao YT, Lin J, Weng CL
QJM 2023 Oct 6;116(9):781-783. doi: 10.1093/qjmed/hcad097. PMID: 37202351
Singh B, Goyal A, Singh G, Chhabra ST, Aslam N, Mohan B, Wander GS
Ann Emerg Med 2021 Oct;78(4):532-534. doi: 10.1016/j.annemergmed.2021.04.014. PMID: 34563298
Isserman RS, Simpao AF, Schwartz AJ, Pearsall MF
Anesthesiology 2017 Sep;127(3):567. doi: 10.1097/ALN.0000000000001618. PMID: 28346324
Richter S, Duray G, Hohnloser SH
Heart Rhythm 2005 Nov;2(11):1268-71. doi: 10.1016/j.hrthm.2005.07.020. PMID: 16253922

Therapy

Wei Z, Xu F, Zhao YT
QJM 2024 Mar 27;117(3):216-217. doi: 10.1093/qjmed/hcad260. PMID: 37982757
Verrier RL, Pang TD, Nearing BD, Schachter SC
Neurol Clin 2022 Nov;40(4):699-716. Epub 2022 Jun 29 doi: 10.1016/j.ncl.2022.03.003. PMID: 36270685
Singh B, Goyal A, Singh G, Chhabra ST, Aslam N, Mohan B, Wander GS
Ann Emerg Med 2021 Oct;78(4):532-534. doi: 10.1016/j.annemergmed.2021.04.014. PMID: 34563298
Ola O, Gharacholou SM, Del-Carpio Munoz F
JAMA Intern Med 2021 Oct 1;181(10):1393-1395. doi: 10.1001/jamainternmed.2021.4021. PMID: 34459879
Cygankiewicz I
Prog Cardiovasc Dis 2013 Sep-Oct;56(2):160-71. Epub 2013 Aug 29 doi: 10.1016/j.pcad.2013.08.002. PMID: 24215748

Prognosis

Cygankiewicz I
Prog Cardiovasc Dis 2013 Sep-Oct;56(2):160-71. Epub 2013 Aug 29 doi: 10.1016/j.pcad.2013.08.002. PMID: 24215748
Myles RC, Jackson CE, Tsorlalis I, Petrie MC, McMurray JJ, Cobbe SM
Circulation 2007 Dec 18;116(25):2984-91. doi: 10.1161/CIRCULATIONAHA.107.699918. PMID: 18086940
El-Sherif N, Turitto G
Curr Opin Cardiol 2003 Jan;18(1):6-13. doi: 10.1097/00001573-200301000-00002. PMID: 12496496
Bloomfield DM, Hohnloser SH, Cohen RJ
J Cardiovasc Electrophysiol 2002 May;13(5):502-12. doi: 10.1046/j.1540-8167.2002.00502.x. PMID: 12030535
Osman AF, Gold MR
Curr Opin Cardiol 2002 Jan;17(1):1-5. doi: 10.1097/00001573-200201000-00001. PMID: 11790927

Clinical prediction guides

de Oliveira Antunes M, Samesima N, Pereira Filho HG, Matsumoto AY, Verrier RL, Pastore CA, Arteaga-Fernández E, Mady C
J Electrocardiol 2017 Mar-Apr;50(2):184-190. Epub 2016 Oct 28 doi: 10.1016/j.jelectrocard.2016.10.010. PMID: 27916321
Dobson CP, Kim A, Haigney M
Prog Cardiovasc Dis 2013 Sep-Oct;56(2):186-94. Epub 2013 Oct 4 doi: 10.1016/j.pcad.2013.07.004. PMID: 24215750
Myles RC, Jackson CE, Tsorlalis I, Petrie MC, McMurray JJ, Cobbe SM
Circulation 2007 Dec 18;116(25):2984-91. doi: 10.1161/CIRCULATIONAHA.107.699918. PMID: 18086940
Can I, Aytemir K, Köse S, Oto A
Card Electrophysiol Rev 2002 Sep;6(3):278-81. doi: 10.1023/a:1016341311646. PMID: 12114852
Bloomfield DM, Hohnloser SH, Cohen RJ
J Cardiovasc Electrophysiol 2002 May;13(5):502-12. doi: 10.1046/j.1540-8167.2002.00502.x. PMID: 12030535

Recent systematic reviews

Schipaanboord DJM, Woudstra J, Appelman Y, Rittersma SZH, van de Hoef TP, van Es R, Coronel R, Damman P, van der Harst P, Onland-Moret NC, den Ruijter HM
Ann Noninvasive Electrocardiol 2024 Sep;29(5):e70003. doi: 10.1111/anec.70003. PMID: 39206616Free PMC Article
Milaras N, Dourvas P, Doundoulakis I, Sotiriou Z, Nevras V, Xintarakou A, Laina A, Soulaidopoulos S, Zachos P, Kordalis A, Arsenos P, Archontakis S, Antoniou CK, Tsiachris D, Dilaveris P, Tsioufis K, Sideris S, Gatzoulis K
Heart Fail Rev 2023 Jul;28(4):865-878. Epub 2023 Mar 6 doi: 10.1007/s10741-023-10300-x. PMID: 36872393Free PMC Article
Disertori M, Masè M, Rigoni M, Nollo G, Ravelli F
Circ Arrhythm Electrophysiol 2016 Dec;9(12) doi: 10.1161/CIRCEP.116.004610. PMID: 27879279
Quan XQ, Zhou HL, Ruan L, Lv JG, Yao JH, Yao F, Huang K, Zhang CT
BMC Cardiovasc Disord 2014 Dec 20;14:198. doi: 10.1186/1471-2261-14-198. PMID: 25528490Free PMC Article
Calò L, De Santo T, Nuccio F, Sciarra L, De Luca L, Stefano LM, Piroli E, Zuccaro L, Rebecchi M, de Ruvo E, Lioy E
Ann Noninvasive Electrocardiol 2011 Oct;16(4):388-402. doi: 10.1111/j.1542-474X.2011.00467.x. PMID: 22008495Free PMC Article

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