Pseudo-Electrical Alternans: Beyond Pericardial Effusion

Abstract

Electrical alternans on ECG is reported in substantial pericardial effusion. Pseudo Electrical alternans (pseudoEA) is the alternation in the QRS amplitude in the absence of pericardial effusion. We reviewed 16 such cases of pseudoEA (26-72 years, 68.75% males, 31.25% females). Besides physiological causes, cardiac diagnosis included arrhythmia (31.25%), coronary artery disease (18.75%), congestive heart failure (12.5%) in our review. The most common non-cardiac diagnosis was bronchial asthma. PseudoEA in both chest and limb leads was seen in 42.8%, chest leads alone in 35.7%, and limb leads alone in 21.4%. Telemetry surveillance is useful in identifying pseudoEA and confirms it by its reversal after treating the main pathology or removing the causing agent. There should be a high index of suspicion amongst physicians when electrical alternans is present on telemetry to identify and treat the alternative conditions in the absence of pericardial effusion.