Giant drug-induced QT prolongation > 800 ms with alternans of terminal portion of T wave and J wave in a normothermic patient

We describe a case of an 85-year-old woman admitted to hospital because of syncope with palpitations. The patient had mistakenly taken sotalol 120 mg/d together with carvedilol 6.25 mg/d. On hospital admission, ECG showed sinus bradycardia 52 bpm with marked QT prolongation: QTc presented variability from beat to beat (840 ms - 640 ms - 820 ms - 640 ms, respectively) with associated macro-alternans of T wave. T wave alternans was observed within the ascending portion of negative T wave. Beside it a J wave was seen.