Heart 1998;80:303-306 ( September )
Case report
T wave alternans after sotalol: evidence for increased
sensitivity to sotalol after conversion from atrial fibrillation to
sinus rhythm
a Department of
Cardiology, University of Amsterdam, Academic Medical Center,
Amsterdam, Netherlands, b Department of Cardiology, Heart Lung Institute,
Utrecht University Hospital, Utrecht, Netherlands
Correspondence to: Dr H L Tan, Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam ZO, Netherlands.
Accepted for publication 24 April 1998
A 64 year old woman with an 11 year history of paroxysmal
atrial fibrillation presented to the emergency room because of
palpitations that had started two weeks previously. She had used
sotalol 80 mg once daily for three years without any episodes of
proarrhythmia or other adverse effects. However, she developed
pronounced T wave alternans with giant inverted T waves and excessive
QT prolongation following sotalol administration one day after
conversion from atrial fibrillation to sinus rhythm. This case
demonstrates bizarre T wave changes, T wave alternans, and extreme QT
prolongation following sotalol administration shortly after conversion
from atrial fibrillation to sinus rhythm. In this situation, sotalol administration may be proarrhythmic, because it enhances repolarisation inhomogeneities based on a spatially inhomogeneous distribution of
repolarisation controlling ion channels to induce repolarisation abnormalities that may lead to torsade de pointes.
© 1998 by Heart
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