Optimizing the detection of macroscopic T-wave alternans using high precordial leads in a patient with Brugada syndrome

A 31-year-old man was resuscitated after cardiopulmonary arrest due to ventricular fibrillation. Physical examination, laboratory tests, echocardiography, and coronary angiography did not show any abnormalities. Five days after resuscitation, standard 12-lead electrocardiogram (ECG) showed spontaneous macroscopic T-wave alternans (TWA) in the V2 lead. In addition, QT interval alternans (480 –520 ms) were observed (PanelA, arrows). At the same time, an ECG recorded with the V1 –V6 leads placed one intercostal space higher showed pronounced TWA in the V2 lead. Furthermore, TWA manifested in the V1 and V3 leads (PanelB, arrows). Standard electrode position can identify specific Brugada ECG changes; however, this may lead to the underestimation of macroscopic TWA. Our case suggests that a less obvious TWA recorded with a standard ECG may be more obvious when using higher precordial leads.
Source: Europace - Category: Cardiology Source Type: research