Auditory Stimuli as a Major Cause of Syncope in a Patient with Idiopathic Long QT Syndrome

A 35-year-old woman was hospitalized due to frequent attacks of syncope immediately after the ringing of a bell or alarm clock. Her standard electrocardiograms showed a long QT interval (QTc=0.56 s) with a bizarre T-wave inversion in precordial leads. After admission, a total of 9 events of syncope...

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Bibliographic Details
Published in:	JAPANESE CIRCULATION JOURNAL Vol. 59; no. 4; pp. 241 - 246
Main Authors:	Nakajima, Toshiaki, Misu, Kazuhiko, Iwasawa, Kuniaki, Tamiya, Eiji, Segawa, Kazuhiko, Matsuo, Hiroshi, Hada, Katuyuki
Format:	Journal Article
Language:	English
Published:	Kyoto The Japanese Circulation Society 01-04-1995 Japanese Circulation Society
Subjects:	Acoustic Stimulation Adult Auditory stimuli Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Female Heart Humans Idiopathic long QT syndrome Long QT Syndrome - complications Long QT Syndrome - physiopathology Medical sciences Risk Factors Syncopal attacks Syncope - etiology Tachycardia, Ventricular - etiology Human Arrhythmia Pathophysiology Cardiogenic syncope Idiopathic Prolonged QT interval Cardiovascular disease Excitability disorder Syndrome Ventricular fibrillation Case study Acoustic stimulus Complication Paroxysmal ventricular tachycardia
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Summary:	A 35-year-old woman was hospitalized due to frequent attacks of syncope immediately after the ringing of a bell or alarm clock. Her standard electrocardiograms showed a long QT interval (QTc=0.56 s) with a bizarre T-wave inversion in precordial leads. After admission, a total of 9 events of syncope were observed. Malignant ventricular tachyarrhythmia (torsade de pointes, ventricular flutter or fibrillation) was recorded during each episode, and DC shock was required to abolish such tachyarrhythmias on 3 occasions. On monitored electrocardiograms, an additional 8 events of ventricular tachycardia without syncope were also detected. Auditory stimuli appeared to be involved in the initiation of malignant ventricular arrhythmia. Immediately after auditory stimuli, changes in the QT interval and T-wave morphology resulted in ventricular premature beats, leading to ventricular tachycardia. The episodes of syncope or malignant ventricular arrhythmia were frequently observed early in the morning and near midnight. She had been treated with various types of antiarrhythmic agents, and propranolol was the most effective in preventing ventricular arrhythmia. These findings indicate that auditory stimuli may cause ventricular arrhythmia and subsequent cardiac syncope, or even sudden cardiac death, in some patients with long QT syndrome.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0047-1828 1347-4839
DOI:	10.1253/jcj.59.241