Cardiac and non-cardiac causes of T-wave inversion in the precordial leads in adult subjects: A Dutch case series and review of the literature

Figure 8 Patient 8. Electrocardiographic (ECG) tracing, demonstrating negative T-wave in the precordial leads V_1-5, microvoltage in the standard leads and an Epsilon wave (arrow) which can be appreciated on magnification of ECG lead V₂, of a 73-year-old man, amateur marathon runner after successful resuscitation for OHCA due to ventricular fibrillation. His coronary angiography and transthoracic echocardiography were normal. Genetic counseling revealed mutation 1238C > A (Tyr616X) in the plakophilline2 gen, compatible with AC. He refused implantable cardioverter defibrillator implantation and remained on medical treatment including class III antiarrhythmic drug. He was advised to refrain from marathon running and other strenuous exercise.