Cardiac alternans and ventricular fibrillation: A bad case of ryanodine receptors reneging on their duty

摘要

Since the first description in 1872 of cardiac alternans by Traube1 in a patient with alcoholic cardiomyopathy, there has been significant progress in understanding the significance of this clinical sign of heart disease. Traube reported this phenomenon before Einthoven invented the ECG in 1903. Thus, he actually described pulsus alternans in his patient, a strong-weak arterial pulse alternation perceptible by unaided finger tact. The patient died shortly after diagnosis, but because he had severe cardiomyopathy, cardiac alternans was not recognized as an ancillary index of disease severity or as a harbinger of mortality. Later, the introduction of ECGs in the routine examination of patients made it clear that cardiac alternans, in the form of T-wave alternans, was a common sign in several cardiomyopathies, such as heart failure, coronary artery disease, genetic and acquired channelopathies, and even in electrolyte disturbances of the body.