Electrical alternans in wide complex tachycardias

Abstract

The occurrence of electrical alternation of 0.1 mV or greater of the QRS or T wave was analyzed in 156 electrocardiograms that showed wide QRS complex tachycardias from 91 patients. One hundred thirty-six ventricular tachycardias (VT) were recorded from 74 patients and 20 supraventricular tachycardias (SVT) from 17 patients. Alternans was present in 42 tracings (27%) from 35 patients (38%) and was equally frequent in the patients with VT (39%) and those with SVT (35%). Alternans occurred in 36 VTs (27%) and 6 SVTs (30%). Tachycardias with alternans had a shorter mean cycle length than tachycardias without alternans (339 +/- 53 vs 368 +/- 85 ms, p less than 0.05), but were not associated with a particular QRS morphology or axis. Alternans was most frequent in leads V2 and V3 and was seen in more leads during SVT than VT (7.2 +/- 2.6 vs 3.7 +/- 2.5, p less than 0.005). All SVTs with alternans incorporated an atrioventricular bypass tract. Electrical alternans occurs frequently in wide QRS tachycardias. Alone, it does not help differentiate VT from SVT. SVTs utilizing bypass tracts frequently show alternans even if the QRS is wide, and this finding may be useful in determining the mechanism of SVTs with aberrant intraventricular conduction.