U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

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
Long QT syndrome (LQTS) is a cardiac electrophysiologic disorder, characterized by QT prolongation and T-wave abnormalities on the EKG that are associated with tachyarrhythmias, typically the ventricular tachycardia torsade de pointes (TdP). TdP is usually self-terminating, thus causing a syncopal event, the most common symptom in individuals with LQTS. Such cardiac events typically occur during exercise and emotional stress, less frequently during sleep, and usually without warning. In some instances, TdP degenerates to ventricular fibrillation and causes aborted cardiac arrest (if the individual is defibrillated) or sudden death. Approximately 50% of untreated individuals with a pathogenic variant in one of the genes associated with LQTS have symptoms, usually one to a few syncopal events. While cardiac events may occur from infancy through middle age, they are most common from the preteen years through the 20s. Some types of LQTS are associated with a phenotype extending beyond cardiac arrhythmia. In addition to the prolonged QT interval, associations include muscle weakness and facial dysmorphism in Andersen-Tawil syndrome (LQTS type 7); hand/foot, facial, and neurodevelopmental features in Timothy syndrome (LQTS type 8); and profound sensorineural hearing loss in Jervell and Lange-Nielson syndrome.
Long QT syndrome 14
MedGen UID:
864108
Concept ID:
C4015671
Disease or Syndrome
Long QT syndrome (LQTS) is a cardiac electrophysiologic disorder, characterized by QT prolongation and T-wave abnormalities on the EKG that are associated with tachyarrhythmias, typically the ventricular tachycardia torsade de pointes (TdP). TdP is usually self-terminating, thus causing a syncopal event, the most common symptom in individuals with LQTS. Such cardiac events typically occur during exercise and emotional stress, less frequently during sleep, and usually without warning. In some instances, TdP degenerates to ventricular fibrillation and causes aborted cardiac arrest (if the individual is defibrillated) or sudden death. Approximately 50% of untreated individuals with a pathogenic variant in one of the genes associated with LQTS have symptoms, usually one to a few syncopal events. While cardiac events may occur from infancy through middle age, they are most common from the preteen years through the 20s. Some types of LQTS are associated with a phenotype extending beyond cardiac arrhythmia. In addition to the prolonged QT interval, associations include muscle weakness and facial dysmorphism in Andersen-Tawil syndrome (LQTS type 7); hand/foot, facial, and neurodevelopmental features in Timothy syndrome (LQTS type 8); and profound sensorineural hearing loss in Jervell and Lange-Nielson syndrome.
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
Scirica BM
J Am Coll Cardiol 2010 Apr 6;55(14):1403-15. doi: 10.1016/j.jacc.2009.09.071. PMID: 20359589
Armoundas AA, Cohen RJ
Card Electrophysiol Rev 1997;1(3):390-4. doi: 10.1023/a:1009902030340. PMID: 11541510

Recent clinical studies

Etiology

Verrier RL, Pang TD, Nearing BD, Schachter SC
Epilepsia 2021 Aug;62(8):1780-1789. Epub 2021 Jul 8 doi: 10.1111/epi.16966. PMID: 34236079
Marcantoni I, Sbrollini A, Agostinelli G, Surace FC, Colaneri M, Morettini M, Pozzi M, Burattini L
Ann Noninvasive Electrocardiol 2020 Jul;25(4):e12745. Epub 2020 Jan 27 doi: 10.1111/anec.12745. PMID: 31986237Free PMC Article
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
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
Verrier RL, Malik M
J Electrocardiol 2013 Nov-Dec;46(6):580-4. Epub 2013 Aug 12 doi: 10.1016/j.jelectrocard.2013.07.003. PMID: 23948521

Diagnosis

Marcantoni I, Sbrollini A, Agostinelli G, Surace FC, Colaneri M, Morettini M, Pozzi M, Burattini L
Ann Noninvasive Electrocardiol 2020 Jul;25(4):e12745. Epub 2020 Jan 27 doi: 10.1111/anec.12745. PMID: 31986237Free PMC Article
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
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
Merchant FM, Sayadi O, Moazzami K, Puppala D, Armoundas AA
Curr Cardiol Rep 2013 Sep;15(9):398. doi: 10.1007/s11886-013-0398-7. PMID: 23881581Free PMC Article
Verrier RL, Malik M
J Electrocardiol 2013 Nov-Dec;46(6):585-90. Epub 2013 Jul 16 doi: 10.1016/j.jelectrocard.2013.06.006. PMID: 23870659

Therapy

Kaufmann DK, Raczak G, Szwoch M, Wabich E, Świątczak M, Daniłowicz-Szymanowicz L
Cardiol J 2022;29(6):1004-1012. Epub 2020 Oct 1 doi: 10.5603/CJ.a2020.0129. PMID: 33001423Free PMC Article
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
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
Chen Z, Shi Y, Hou X, Xu S, Zou J
Int J Cardiol 2013 Sep 1;167(5):2061-5. Epub 2012 Jun 8 doi: 10.1016/j.ijcard.2012.05.050. PMID: 22683284
Verrier RL, Nieminen T
J Cardiovasc Pharmacol 2010 Jun;55(6):544-54. doi: 10.1097/FJC.0b013e3181d6b781. PMID: 20555232

Prognosis

Lewek J, Ptaszynski P, Klingenheben T, Cygankiewicz I
Europace 2017 Apr 1;19(4):529-534. doi: 10.1093/europace/euw292. PMID: 28339589
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
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
Verrier RL, Malik M
J Electrocardiol 2013 Nov-Dec;46(6):580-4. Epub 2013 Aug 12 doi: 10.1016/j.jelectrocard.2013.07.003. PMID: 23948521
Verrier RL, Malik M
J Electrocardiol 2013 Nov-Dec;46(6):585-90. Epub 2013 Jul 16 doi: 10.1016/j.jelectrocard.2013.06.006. PMID: 23870659

Clinical prediction guides

Lewek J, Ptaszynski P, Klingenheben T, Cygankiewicz I
Europace 2017 Apr 1;19(4):529-534. doi: 10.1093/europace/euw292. PMID: 28339589
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
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
Verrier RL, Malik M
J Electrocardiol 2013 Nov-Dec;46(6):580-4. Epub 2013 Aug 12 doi: 10.1016/j.jelectrocard.2013.07.003. PMID: 23948521
Merchant FM, Sayadi O, Moazzami K, Puppala D, Armoundas AA
Curr Cardiol Rep 2013 Sep;15(9):398. doi: 10.1007/s11886-013-0398-7. PMID: 23881581Free PMC Article

Recent systematic reviews

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
van der Avoort CJ, Filion KB, Dendukuri N, Brophy JM
BMC Cardiovasc Disord 2009 Jan 28;9:5. doi: 10.1186/1471-2261-9-5. PMID: 19175926Free PMC Article

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Consumer resources

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...