Education  |   September 2017
T-wave Alternans and Long QT Syndrome
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, and The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.
  • Address correspondence to Dr. Isserman: issermanr@email.chop.edu
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   September 2017
T-wave Alternans and Long QT Syndrome
Anesthesiology 9 2017, Vol.127, 567. doi:10.1097/ALN.0000000000001618
Anesthesiology 9 2017, Vol.127, 567. doi:10.1097/ALN.0000000000001618
T-WAVE alternans is an uncommonly observed electrocardiographic (ECG) finding of beat-to-beat alternation in T-wave shape or amplitude (A, operating room monitor; B, ECG rhythm strip). “Macroscopic” T-wave alternans, visible to the naked eye, is associated with a prolonged QT interval and long QT syndrome (LQTS). T-wave alternans may portend a rapidly developing and life-threatening scenario, and its recognition is crucial to prevent progression to lethal arrhythmias.1 
T-wave alternans developed in a 2-yr-old, 15-kg boy without known cardiac history who was undergoing general anesthesia with sevoflurane for syndactyly surgery. When T-wave alternans is suspected, intraoperative cardiology consultation is appropriate to assist with this often-unfamiliar ECG abnormality that may degenerate quickly to torsades de pointes. Immediate treatment should begin with 20 to 30 mg/kg of intravenous magnesium and preparation for defibrillation.
First Page Preview
First page PDF preview
First page PDF preview ×
View Large