T wave abnormalities

Dr. Nithin P. G.

Post extrasystolic

Postextrasystolic T wave inversion

• 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

• 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, post-LBBB, and post-preexcitation abnormalities.”

Macfarlane et al, Electrocardiography- comprehensive clinical cardiology , Springer 2012 edition.

Post pacing

• 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”

Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008

Post pacing

After intermittent preexcitation

Day 1 ablationDay 40 ablation

Pre-ablation

J Cardiovasc Electrophysiol 7:51, 1996

After intermittent LBBB

American Journal of Emergency Medicine (2010) 28, 747.e5–747.e6

Transient T wave abnormalitiesCardiac 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 1

Phase 2&3

Phase 2&3

Thank you