case_images: PMC11390421_01
case_images: ECGs of the patient. (A) ECG illustrating ventricular fibrillation and defibrillation (red arrow). (B) ECG after defibrillation displays sinus rhythm, QTc prolongation (655 ms), and T wave alternans. The distinct beat-to-beat alternation of the T-wave structure with a repeating ABABAB pattern is observed in lead V1. (C) ECG before discharge displays QTc 509 ms and improved T-wave morphology. (D) ECG after 6 months follow-up displays QTc 490 ms. Heart rate correction of QT interval was performed by Bazett's formula. ECG, electrocardiography.
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case_images: F1
case_images: She suddenly developed VF during the visit, which was treated with 200-J shock twice (Figure 1A). Electrocardiography (ECG) after defibrillation demonstrated QTc prolongation (655 ms, QTc was performed using the Bazett's formula) and T wave alternans (TWA), which manifested as a beat-to-beat alternation of the T wave structure with a repeating AB pattern annotated in lead V1 (Figure 1B). QTc shortened to 558 ms and TWA disappeared after correcting electrolyte disturbance (Supplementary Figure S1). Before discharge on day 21, repeated ECG suggested QTc of 509 ms and improved T wave morphology (Figure 1C). QTc interval shortened to 490 ms (Figure 1D) and LVEF increased to 42%.
case_images: CXR on admission (A) and before discharge (B) CXR, chest x-ray.
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case_images: F2
case_images: Chest x-ray (CXR) displayed bilateral diffuse infiltration, mild left hydrothorax, and enlarged heart shadow (Figure 2A). Her baseline ECG and UCG were normal before initiating osimertinib, with QTc of 451 ms, LVEDD of 49 mm, and LVEF of 60% (Supplementary Figure S2). NT-proBNP gradually declined to 491 pg/ml, and repeated CXR suggested improved effusion and smaller heart shadow (Figure 2B).
case_images: Recurrent TdP. (A) TdP with a "short-long-short" pattern of R-R cycles (red and green arrows) before intravenous ISO administration. (B) TdP recurrence when the HR decreases to the baseline level after terminating ISO. TdP disappears for 90 min with HR >60 bpm because of the use of ISO. HR, heart rate; ISO, isoproterenol; TdP, Torsade de Pointes.
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case_images: F3
case_images: TdP (Figure 3A). The patient had no family history of dilated cardiomyopathy, ventricular arrhythmias (VAs), syncope, and sudden cardiac death. TdP recurred when the HR decreased to 60 bpm, thus confirming the efficacy of ISO (Figure 3B).
case_images: ECG during intravenous ISO administration. Shortness of QTc from 558 ms to 519 ms with HR from 63 bpm to 89 bpm is observed, along with improved T wave morphology in the precordial leads from inversion to upright (red arrow). ISO, isoproterenol; ECG, electrocardiography.
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case_images: PMC11390421_01_fcvm-11-1423647-g004.jpg
case_images: F4
case_images: T wave morphology (Figure 4). The recurrent TdP was terminated.