ST-T Alternans as a Risk Predictor for Fatal Ventricular Arrhythmia

To the Editor Xu et al present the electrocardiogram findings of a patient in their 50s with syncope and palpitation and amaurosis, followed by loss of consciousness for several minutes without preceding position change, cough, chest pain, or shortness of breath. The authors highlight that “giant R-wave syndrome is distinguished by delayed depolarization and repolarization of the myocardium, which is a predictor of the onset of ventricular fibrillation.” The authors focused only on giant R-wave syndrome as a predictive factor for ventricular arrhythmias in patients with acute myo cardial infarction and ignored the presence of cardiac electrical alternances. Obvious in the Holter recording (Figure in the case report) is a clear macro–ST-T–wave alternans observed in leads V2 through V4. Therefore, it is reasonable to conclude that, in addition to the presence of giant R-wa ve syndrome, the electrical alternans of ST-T may play a more crucial role in polymorphic ventricular tachycardia. ST-T alternans have been associated with spontaneous ventricular arrhythmias during myocardial ischemia.
Source: JAMA Internal Medicine - Category: Internal Medicine Source Type: research