Sotalol Sensitivity

Report:

Atrial ?junctional bradycardia 42/min

VEB

Long QTc 0.54”

Comment:

The first beat is distorted by movement artefact: its repolarisation in L1 and L3 and preserved QRS shape in simultaneous L2 distinguish it from a VEB.

The striking abnormality is the long QT interval 0.65” giving a QTc of 0.54” for the rate of 42/min. It is not possible to dissect out a separate U wave except in leads V2 and V3. Fortunately, it makes little difference in this setting: large U wave would have the same significance as long QT interval.

The expected happened (Fig 127a) but the patient survived. The QT interval normalised within 36 hours.

127a. Torsade de pointes. 128. 77 year old man in ICU following uncomplicated CABGs.

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