T wave abnormalities
Dr. Nithin P. G.
Post extrasystolic
• First postextrasystolic complex
[sometimes second or third] show
occasional primary T wave
changes [T wave inversion with
prolongation of the QT interval]
• Cause unknown- Asynchronous
repolarization during adjustment
to a new cycle length
Postextrasystolic T wave inversion
• More frequently in patients with
heart disease
Macfarlane et al, Electrocardiography- comprehensive clinical cardiology ,
Springer 2012 edition.
Post-tachycardia
“In about 20 % of pts with paroxysmal tachycardia, the normal
upright T wave becomes inverted for hours or days after
termination of the episode or interruption of tachycardia by
ablation. This may occur after VT or SVT and is unrelated to the
age of the patient or to the presence or absence of heart disease.”
Macfarlane et al, Electrocardiography- comprehensive clinical cardiology ,
Springer 2012 edition.
[2 days]
[10 days]
[17 days]
Baseline
normal
PSVT
N Engl J Med 1995; 332:161
Post-tachycardia
“ The abnormalities often persist longer than would be expected on
the basis of physiologic adjustment to the new cycle….
…..the mechanism is probably similar to that of the post-pacing, postLBBB, and post-preexcitation abnormalities.”
Macfarlane et al, Electrocardiography- comprehensive clinical cardiology ,
Springer 2012 edition.
Post pacing
Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition.
Saunders Elsevier 2008
•
a Duration of pacing and the amount of energy applied during pacing
•
Site of stimulation determines the vector of the T wave
•
“presence of abnormal depolarization in the stimulated area”
Post pacing
After intermittent preexcitation
Pre-ablation
Day 40 ablation
Day 1 ablation
J Cardiovasc Electrophysiol 7:51, 1996
After intermittent LBBB
American Journal of Emergency Medicine (2010) 28, 747.e5–747.e6
Transient T wave abnormalities
Cardiac memory (Rosenbaum et al. 1982)/ electrical
remodeling - Primary T wave abnormalities following
normalization of intra-ventricular conduction only
gradually disappear
– “AP prolongation over the preexcited area” -they persist
– Manifestation of repolarization “memory.” [abnormal sequence of
activation is “remembered” for some time after return to a normal
activation pattern]
Phase 2&3
Phase 1
Phase 2&3
Thank you