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Giant T–U Waves Precede Torsades de Pointes in Long QT Syndrome
Open accessAbstract
Objectives This study sought to identify electrocardiographic (ECG) criteria that are associated with initiation of torsades de pointes (TdP) in patients with acquired (a-) and congenital (c-) long QT syndrome (LQTS).Background Electrocardiographic criteria used as risk predictors for TdP commonly rely on a prolonged QT interval but rarely consider abnormal T-U waves.Methods We analyzed ECG recordings with TdP from 35 LQTS patients (15 c-LQTS and 20 a-LQTS) and compared them with premature ventricular complexes (PVCs) from 40 patients with normal QT intervals and with PVCs in 24 of the 35 LQTS patients not related to TdP.Results Abnormal T-U waves (6.2 +/- 0.9 mm) directly preceded TdP in 34 of 35 LQTS patients and were larger than T-wave amplitude (2.8 +/- 0.2 mm) in control patients and larger than the largest T-U-wave in LQTS without TdP (4.7 +/- 0.8 mm). The TdP-initiating beat emerged from a T-U-wave in 27 of 35 LQTS patients and in none of 40 control patients. The QRS duration of the first TdP beat (175 +/- 12 ms) was longer than in control PVCs (145 +/- 4 ms) and in PVCs in LQTS patients not related to TdP (138 +/- 22 ms). The QRS angle was less steep before TdP than in other PVCs (all p < 0.05).Conclusions Abnormal, giant T-U waves separate TdP initiation in LQTS patients from PVCs in other heart disease and from other PVCs in LQTS patients. These ECG analyses suggest that early afterdepolarizations initiate TdP and, if present, may help to identify an imminent risk for TdP.
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“the presence of 'abnormal TU waves' is a sign of imminent torsades de pointes.652”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [652]
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Risk Stratification in the Long-QT Syndrome
Priori, S. G., Schwartz, P. J., Napolitano, C., Bloise, R., Ronchetti, E., Grillo, M., Vicentini, A., Spazzolini, C., Nastoli, J., Bottelli, G., et al. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022147 · Cited by 1,456
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Long QT syndromes and torsade de pointes
Viskin, S. (1999) · The Lancet · doi:10.1016/s0140-6736(99)02107-8 · Cited by 690
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Mode of onset of torsade de pointes in congenital long QT syndrome
Viskin, S., Alla, S. R., Barron, H. V., Heller, K., Saxon, L. A., Kitzis, I., Hare, G. F. V., Wong, M. J., Lesh, M. D., & Scheinman, M. M. (1996) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(96)00311-7 · Cited by 162
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Bayés‐Genís, A., Fiol, M., Bayés‐Genís, A., Baranchuk, A. M., Elosúa, R., & Martínez‐Sellés, M. (2021) · Wiley eBooks · doi:10.1002/9781119536475.ch21
Bayés‐Genís, A., Fiol, M., Bayés‐Genís, A., Baranchuk, A. M., Elosúa, R., & Martínez‐Sellés, M. (2021) · doi:10.1002/9781119536475.ch24
de Luna, A. B., & FCCS, A. B. M. F. F. (2017) · Wiley eBooks · doi:10.1002/9781119212782.ch9
de Luna, A. B. (2011) · Wiley eBooks · doi:10.1002/9781444391749.ch9
Important unanswered research questions related to torsades de pointes
Roston, T. M., Roberts, J. D., Laksman, Z., & Krahn, A. D. (2022) · Elsevier eBooks · doi:10.1016/b978-0-12-821446-6.00003-1
de Luna, A. B., & FCCS, A. B. M. F. F. (2017) · doi:10.1002/9781119212782.ch10
de Luna, A. B. (2011) · doi:10.1002/9781444391749.ch10
Yeo, T. C. (2026) · Springer eBooks · doi:10.1007/978-981-96-7667-5_2
Metadata
- Authors
- Kirchhof, P., Franz, M. R., Bardai, A., & Wilde, A. M.
- Affiliations
- Georgetown University (US)
- University Hospital Münster (DE)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Franz, Michael R.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2009-07
- Volume
- 54
- Issue
- 2
- Pages
- 143-149
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2128940750
- Cited by
- 112
- References
- 31
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 6 · 2021: 9 · 2020: 8 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 12 · 2015: 7 · 2014: 11 · 2013: 8 · 2012: 6
- FWCI
- 6.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- long QT syndrome, torsades de pointes, premature ventricular contractions, early afterdepolarizations, QRS duration, congenital long QT syndrome, acquired long QT syndrome
- MeSH terms
- Adult, Aged, Diagnosis, Differential, Electrocardiography, Female, Follow-Up Studies, Heart Rate, Humans, Long QT Syndrome, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Torsades de Pointes, Ventricular Premature Complexes
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