Key result
Macroscopic T-wave alternans warns of impending torsades de pointes and ventricular fibrillation in QT prolongation.
Why the study?
Macroscopic T-wave alternans as a marker of repolarization instability preceding malignant ventricular arrhythmias in QT prolongation was highlighted in this case.
Case Report (n=1)
Macroscopic T-wave alternans is an ominous electrocardiographic marker of profound repolarization instability and imminent polymorphic ventricular tachycardia.
Answers are grounded in this paper and cite their sources.
Macroscopic T-wave alternans signals imminent ventricular arrhythmias in alcohol withdrawal; leaves open its value for risk stratification beyond case reports.
CASE SUMMARY: A 28-year-old man with alcohol use disorder presented with delirium tremens and electrocardiographic QT prolongation with macroscopic T-wave alternans, followed by torsades de pointes and ventricular fibrillation. Echocardiography demonstrated a dilated left ventricle with an ejection fraction <20%. The findings highlighted profound repolarization instability preceding malignant ventricular arrhythmias. TAKE-HOME MESSAGE: Macroscopic T-wave alternans is an ominous electrocardiographic marker of profound repolarization instability and imminent polymorphic ventricular tachycardia, requiring immediate elimination of QT-prolonging factors, correction of electrolyte abnormalities, and prompt initiation of intravenous magnesium sulfate.
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Kamble et al. (2026) conducted a case report in QT prolongation with macroscopic T-wave alternans (n=1). Macroscopic T-wave alternans was evaluated. Macroscopic T-wave alternans served as an ominous marker of profound repolarization instability preceding torsades de pointes and ventricular fibrillation in a patient with QT prolongation.
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