Date: 25 Oct 2013

Postexercise recovery phase T-wave notching in concealed long QT syndrome

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Long QT syndrome (LQTS) is an electrical disease of the ventricular myocardium that is characterized by prolonged ventricular repolarization, which results in prolongation of the QT interval on surface electrocardiograms (ECGs) and an increased risk of torsade de pointes (TdP) and sudden cardiac death (SCD) [1].Cardiac dysrhythmias can be initiated by an external trigger, such as emotional stress, exercise, or sudden loud noises (i.e., an alarm clock or telephone) [1, 2]. Excellent outcomes in the management of LQTS patients have been achieved by lifestyle modification, beta-blocker therapy, and selective cardioverter-defibrillator (ICD) implantation [1]; however, misdiagnosis of LQTS as epilepsy, particularly“familial epilepsy,” is common [3]. Nearly 40 % of LQTS patients can have a normal-to-borderline QTc interval at rest (concealed LQTS) [4], therefore, an absence of ECG findings of LQTS in family members does not exclude LQTS. Moreover, genetic testing for 13 LQTS susceptibility g