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. Author manuscript; available in PMC: 2011 Mar 13.
Published in final edited form as: Circulation. 2010 Feb 8;121(8):1047–1060. doi: 10.1161/CIRCULATIONAHA.109.192704

Figure 2.

Figure 2

Top rhythm strip, TdP degenerating into ventricular fibrillation in an 83-year-old female hospitalized in the intensive care unit for pneumonia. She was started on intravenous erythromycin several hours before cardiac arrest. A ventricular couplet followed by a pause provided the short-long-short cycle sequence that triggered TdP. Bottom rhythm strip, ECG 1 hour before the onset of TdP shows extreme prolongation of the QT interval (QTc in cycles with larger T waves=730 ms), a ventricular couplet (asterisk), and macroscopic T-wave alternans (vertical arrows). If these signs of impending TdP had been recognized, discontinuation of the culprit drug and administration of magnesium most likely would have prevented the subsequent cardiac arrest.