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Updated: Jun 13, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Pattern of crescendo TWA may disclose the underlying cardiac pathology
Tuomo Nieminen1, Richard L Verrier, Kjell Nikus
1Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. tuomo.nieminen@iki.fi
Abstract:
We present an exercise test case in which crescendo TWA preceded ventricular tachycardia (VT). The patient was examined due to suspicion of ischemic heart disease. The ST-segment became elevated simultaneously with a distinct alternation in the ST-segment and the first half of the T-wave, and the patient developed polymorphic VT. Coronary angiography disclosed marked stenoses. Earlier reports of TWA in patients with congenital long QT syndrome show a pattern in which the T wave frequently alternates above and below the isoelectric line without concomitant ST-segment changes. In Brugada syndrome patients, the signature ST-T wave pattern is the locus of alternation. Future investigation should elucidate whether specific TWA morphologies may expose underlying heart disease.
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