Electrical Alternans Treatment & Management

Updated: Sep 12, 2019
  • Author: Bharat K Kantharia, MD, FRCP, FAHA, FACC, FESC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Approach Considerations

It is important to remember that electrical alternans is just a sign of underlying pathology and not an entity in itself. Evaluation of the electrocardiographic component displaying alternans often provides a clue toward the direction of further investigation. The presence of T-wave alternans in the appropriate clinical setting can play a role in cardiac risk stratification.

Cardiology consultation is usually indicated.


Medical Care

Direct treatment toward correction of the underlying cause of electrical alternans, such as optimizing heart failure or anti-ischemic regimens in patients with cardiomyopathy or coronary disease. In the setting of long QT syndrome (LQTS), remove the offending drugs and correct concomitant dyselectrolytemias. Malignant pericardial effusions require aggressive treatment of the underlying malignancy with aggressive chemotherapy/immunotherapy regimens.

Diet and activity

No specific dietary or activity restrictions are required aside from those required for managing the underlying cause (eg, salt restriction for congestive heart failure; avoidance of stress and strenuous exercise for patients with congenital LQTS).



Surgical Care

Most diseases that cause true electrical alternans do not require surgical treatment. Pulmonary embolectomy may be required for unresolved large pulmonary emboli. Left-sided cervicothoracic sympathetic ganglionectomy may be required for patients with congenital long QT syndrome or malignant arrhythmias whose conditions remain refractory to drug therapy. Recurrent pericardial effusions may benefit from pericardiectomy.