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Duras E, Sulu A, Kafali HC, Sisko SG, Caran B, Ergul Y. Evaluation of T-wave memory after accessory pathway ablation in pediatric patients with Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 2024; 47:1004-1012. [PMID: 38742589 DOI: 10.1111/pace.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/29/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND T-wave memory (TWM) is a rare cause of T-wave inversion (TWI). Alterations in ventricular activation due to abnormal depolarization may cause repolarization abnormalities on the ECG, even if myocardial conduction returns to normal. These repolarization changes are defined as TWM. In our study, we aimed to determine the frequency of TWM development and the predictors affecting it in the pediatric population who underwent accessory pathway (AP) ablation due to Wolff-Parkinson-White (WPW) syndrome. METHODS The data of patients with manifest AP who underwent electrophysiological studies and ablation between 2015 and 2021 were retrospectively analyzed. The study included 180 patients who were under 21 years of age and had at least one year of follow-up after ablation. Patients with structural heart disease, intermittent WPWs, recurrent ablation, other arrhythmia substrates, and those with less than one-year follow-up were excluded from the study. The ECG data of the patients before the procedure, in the first 24 h after the procedure, three months, and in the first year were recorded. The standard ablation technique was used in all patients. RESULTS Postprocedure TWM was observed in 116 (64.4%) patients. Ninety-three patients (51.7%) had a right-sided AP, and 87 patients (48.3%) had a left-sided AP. The presence of posteroseptal AP was found to be significantly higher in the group that developed TWM. Of these patients, 107 (93.1%) patients showed improvement at the end of the first year. Preprocedural absolute QRS-T angle, postprocedural PR interval, and right posteroseptal pathway location were identified as predictors of TWM. CONCLUSION The development of TWM is particularly associated with the right-sided pathway location, especially the right posteroseptal pathway location. The predictors of TWM are the preprocedural QRS-T angle, the postprocedural PR interval, and the presence of the right posteroseptal AP.
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Affiliation(s)
- Ensar Duras
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Ayse Sulu
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Hasan Candas Kafali
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Sezen Gulumser Sisko
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Bahar Caran
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Yakup Ergul
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Department of Pediatric Cardiology, University of Health Sciences, Istanbul, Turkey
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Silva RRP, Magalhães CJ, Silva RSVD, Tavares de Albuquerque AL, Montenegro ST, Alencar Neto JND. Accelerated idioventricular rhythm as anginous substrate in elderly: Report of an unprecedented case. HeartRhythm Case Rep 2024; 10:217-221. [PMID: 38496744 PMCID: PMC10943551 DOI: 10.1016/j.hrcr.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Rodrigo Rufino Pereira Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Carolina Jerônimo Magalhães
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Rafael Silvestre Vieira da Silva
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Afonso Luiz Tavares de Albuquerque
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
| | - Sérgio Tavares Montenegro
- Division of Cardiology, Pronto Socorro Cardiológico de Pernambuco Prof. Luiz Tavares, University of Pernambuco (PROCAPE/UPE), Recife, Brazil
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3
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Dural M, Ghossein MA, Gerrits W, Daniels F, Meine M, Maass AH, Rienstra M, Prinzen FW, Vernooy K, van Stipdonk AMW. Association of vectorcardiographic T-wave area with clinical and echocardiographic outcomes in cardiac resynchronization therapy. Europace 2023; 26:euad370. [PMID: 38146837 PMCID: PMC10766142 DOI: 10.1093/europace/euad370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
AIMS Data on repolarization parameters in cardiac resynchronization therapy (CRT) are scarce. We investigated the association of baseline T-wave area, with both clinical and echocardiographic outcomes of CRT in a large, multi-centre cohort of CRT recipients. Also, we evaluated the association between the baseline T-wave area and QRS area. METHODS AND RESULTS In this retrospective study, 1355 consecutive CRT recipients were evaluated. Pre-implantation T-wave and QRS area were calculated from vectorcardiograms. Echocardiographic response was defined as a reduction of ≥15% in left ventricular end-systolic volume between 3 and 12 months after implantation. The clinical outcome was a combination of all-cause mortality, heart transplantation, and left ventricular assist device implantation. Left ventricular end-systolic volume reduction was largest in patients with QRS area ≥ 109 μVs and T-wave area ≥ 66 μVs compared with QRS area ≥ 109 μVs and T-wave area < 66 μVs (P = 0.004), QRS area < 109 μVs and T-wave area ≥ 66 μVs (P < 0.001) and QRS area < 109 μVs and T-wave area < 66 μVs (P < 0.001). Event-free survival rate was higher in the subgroup of patients with QRS area ≥ 109 μVs and T-wave area ≥ 66 μVs (n = 616, P < 0.001) and QRS area ≥ 109 μVs and T-wave area < 66 μVs (n = 100, P < 0.001) than the other subgroups. In the multivariate analysis, T-wave area remained associated with echocardiographic response (P = 0.008), but not with the clinical outcome (P = 0.143), when QRS area was included in the model. CONCLUSION Baseline T-wave area has a significant association with both clinical and echocardiographic outcomes after CRT. The association of T-wave area with echocardiographic response is independent from QRS area; the association with clinical outcome, however, is not.
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Affiliation(s)
- Muhammet Dural
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Odunpazarı, Eskişehir 26040, Turkey
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht 6202, The Netherlands
| | - Mohammed A Ghossein
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Willem Gerrits
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Fenna Daniels
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alexander H Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht 6202, The Netherlands
| | - Antonius M W van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+, Maastricht 6202, The Netherlands
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Malik M, Farooqi MS, Karim R, Khan S, Rind IA. Memory T-Waves: An Uncharted Territory in T-Wave Inversions. Cureus 2023; 15:e47620. [PMID: 38022234 PMCID: PMC10667626 DOI: 10.7759/cureus.47620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
T-wave inversions on electrocardiograms (ECGs) can present a diagnostic challenge due to their association with various underlying causes. One less-explored cause is memory T-waves, a phenomenon characterized by T-wave inversions, often seen in chest and inferior leads, following a period of abnormal ventricular conduction. In this case report, we discuss the intriguing case of an 80-year-old woman who recently underwent percutaneous coronary intervention (PCI) for a myocardial infarction and subsequently developed memory T-waves. We are also discussing how important it can be to understand and recognize memory T-waves, as it will avoid further unnecessary tests and longer hospital stays.
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Affiliation(s)
- Munzir Malik
- Acute Medicine, Wrexham Maelor Hospital, Wrexham, GBR
| | | | | | - Saleem Khan
- Medicine, Betsi Cadwaladr University Health Board, Wrexham, GBR
| | - Irfan Ali Rind
- Cardiology, Betsi Cadwaladr University Health Board, Wrexham, GBR
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Naik R, Thyagaturu H, Awad M, Bischof E. The Heart Remembers: A Case of Cardiac Memory. Cureus 2023; 15:e42106. [PMID: 37602025 PMCID: PMC10436023 DOI: 10.7759/cureus.42106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
An 80-year-old male with a history of atrial fibrillation and a single-chamber ventricular pacemaker presented to the hospital for an elective colonoscopy. He experienced a transient episode of unresponsiveness with seizure-like activity before the procedure. This prompted him to get an EKG showing deep T-wave inversions (TWIs) in the precordial leads on a background of paced beats. Such findings were concerning for an acute and potentially life-threatening process such as myocardial infarction (MI) or intracranial insult. After ruling out any severe conditions, the EKG findings were attributed to cardiac memory, an underdiagnosed cause of deep TWIs in patients with a pacemaker.
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Affiliation(s)
- Riddhima Naik
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
| | | | - Maan Awad
- Internal Medicine, West Virginia University School of Medicine, Morgantown, USA
| | - Edward Bischof
- Internal Medicine, Bassett Healthcare Network, Cooperstown, USA
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6
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Abstract
Cardiac memory is the term used to describe an interesting electrocardiographic phenomenon. Whenever a QRS complex is wide and abnormal, such as during ventricular pacing, the T waves will also be abnormal and will point to the opposite direction of the wide QRS. If the QRS then normalizes, such as after cessation of ventricular pacing, the T waves will normalize as well, but at a later stage. The period of cardiac memory is the phase between the sudden normalization of the QRS and the eventual and gradual return of the T waves to their baseline morphology. Cardiac memory is assumed to be an innocent electrocardiographic curiosity. However, during cardiac memory, reduction of repolarizing potassium currents increases left ventricular repolarization gradients. Therefore, when cardiac memory occurs in patients who already have a prolonged QT interval (for whatever reason), it can lead to a frank long QT syndrome with QT-related ventricular arrhythmias (torsades de pointes). These arrhythmogenic effects of cardiac memory are not generally appreciated and are reviewed here for the first time.
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Affiliation(s)
- Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., A.L.S., R.R.)
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., A.L.S., R.R.)
| | - Arie Lorin Schwartz
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., A.L.S., R.R.)
| | - Piotr Kukla
- Department of Internal Medicine and Cardiology, Specialistic Hospital, Gorlice, Poland (P.K.)
| | - Raphael Rosso
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Israel (S.V., E.C., A.L.S., R.R.)
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Vijay S, Deepti S, Singh S. Painful LBBB syndrome: a rare cause of angina. BMJ Case Rep 2022; 15:e246836. [PMID: 35140085 PMCID: PMC8830201 DOI: 10.1136/bcr-2021-246836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/04/2022] Open
Abstract
Painful left bundle branch block (LBBB) syndrome is an uncommon condition that is largely underdiagnosed. In this report, we describe a man in his 40s who had typical rate-dependent LBBB associated with angina without evidence of obstructive coronary artery disease.
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Affiliation(s)
- Soorampally Vijay
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Siddharthan Deepti
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sandeep Singh
- Cardiology, Cardio-Thoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
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8
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QT Prolongation After His Bundle Pacing. JACC Case Rep 2022; 4:181-184. [PMID: 35199013 PMCID: PMC8855124 DOI: 10.1016/j.jaccas.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 11/24/2022]
Abstract
An 82-year-old woman with nonischemic cardiomyopathy underwent cardiac resynchronization therapy by the use of His bundle pacing. After the procedure, the patient had repolarization abnormality with severely prolonged QTc and anterior inferior T-wave inversions, likely resulting from memory T waves associated with the correction of long-standing left bundle branch block. These changes could be potentially arrhythmogenic. (Level of Difficulty: Intermediate.)
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9
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Johnson JA, Haq KT, Lutz KJ, Peters KK, Paternostro KA, Craig NE, Stencel NWL, Hawkinson LF, Khayyat-Kholghi M, Tereshchenko LG. Electrophysiological ventricular substrate of stroke: a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study. BMJ Open 2021; 11:e048542. [PMID: 34479935 PMCID: PMC8420653 DOI: 10.1136/bmjopen-2020-048542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The goal of the study was to determine an association of cardiac ventricular substrate with thrombotic stroke (TS), cardioembolic stroke (ES) and intracerebral haemorrhage (ICH). DESIGN Prospective cohort study. SETTING The Atherosclerosis Risk in Communities (ARIC) study in 1987-1989 enrolled adults (45-64 years), selected as a probability sample from four US communities (Minneapolis, Minnesota; Washington, Maryland; Forsyth, North Carolina; Jackson, Mississippi). Visit 2 was in 1990-1992, visit 3 in 1993-1995, visit 4 in 1996-1998 and visit 5 in 2011-2013. PARTICIPANTS ARIC participants with analysable ECGs and no history of stroke were included (n=14 479; age 54±6 y; 55% female; 24% black). Ventricular substrate was characterised by cardiac memory, spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag), premature ventricular contractions (PVCs) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG at visits 1-5. OUTCOME Adjudicated TS included a first definite or probable thrombotic cerebral infarction, ES-a first definite or probable non-carotid cardioembolic brain infarction. Definite ICH was included if it was the only stroke event. RESULTS Over a median 24.5 years follow-up, there were 899 TS, 400 ES and 120 ICH events. Cox proportional hazard risk models were adjusted for demographics, cardiovascular disease, risk factors, atrial fibrillation, atrial substrate and left ventricular hypertrophy. After adjustment, PVCs (HR 1.72; 95% CI 1.02 to 2.92), QRS-Ta (HR 1.15; 95% CI 1.03 to 1.28), SAIQRST (HR 1.20; 95% CI 1.07 to 1.34) and time-updated SVGmag (HR 1.19; 95% CI 1.08 to 1.32) associated with ES. Similarly, PVCs (HR 1.53; 95% CI 1.03 to 2.26), QRS-Ta (HR 1.08; 95% CI 1.01 to 1.16), SAIQRST (HR 1.07; 95% CI 1.01 to 1.14) and time-updated SVGmag (HR 1.11; 95% CI 1.04 to 1.19) associated with TS. TD-IBBB (HR 3.28; 95% CI 1.03 to 10.46) and time-updated SVGmag (HR 1.23; 95% CI 1.03 to 1.47) were associated with ICH. CONCLUSIONS PVC burden (reflected by cardiac memory) is associated with ischaemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes ICH.
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Affiliation(s)
- John A Johnson
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kazi T Haq
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Katherine J Lutz
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kyle K Peters
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Kevin A Paternostro
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Natalie E Craig
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Nathan W L Stencel
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Lila F Hawkinson
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Maedeh Khayyat-Kholghi
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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10
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Ballet A, Mulleman R, Vandermotte M. The heart remembers what the mind forgets. Acta Clin Belg 2021; 76:310-313. [PMID: 31996105 DOI: 10.1080/17843286.2020.1724449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Cardiac memory, also known as the Chatterjee phenomenon, is a poorly understood, under-recognized but important and benign cause of T-wave inversions. After a period of abnormal ventricular activation, such as ventricular pacing, intermittent left bundle branch block or pre-excitation, the heart 'remembers' and mirrors its repolarization in the direction of the previous QRS. It usually manifests as T-wave inversions that can linger up to weeks after the provocative event.Case summary: An 87-year-old man with extensive cardiovascular history and risk factors presented to the emergency department with shortness of breath and chest pain. An ECG taken on admission revealed deep widespread T wave inversions. Serial high sensitive cardiac troponin (hs-cTn) however remained negative (<10 ng/ml) with a negative D-dimer. Upon reviewing previous ECGs and the medical history, the patient was diagnosed with cardiac memory, which required no further treatment.Conclusion: Cardiac memory should be considered in any patient with a ventricular pacemaker that presents with narrow QRS rhythm and T-wave changes suggestive of ischemia. Although it remains a diagnosis of exclusion, recognizing this important clinical entity can prevent unnecessary admissions, expensive diagnostic tests and invasive procedures.
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Affiliation(s)
- Arne Ballet
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ritchie Mulleman
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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11
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Gunaseelan R, Sasikumar M, Aswin K, Nithya B, Balamurugan N, Vivekanandan M. Memory T-Waves, a Rare Cause of T-Wave Inversion in the Emergency Department. J Emerg Trauma Shock 2021; 13:312-316. [PMID: 33897151 PMCID: PMC8047955 DOI: 10.4103/jets.jets_70_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/22/2020] [Indexed: 12/02/2022] Open
Abstract
One of the rare causes of diffuse T-wave inversion (TWI) in electrocardiogram (ECG) is memory T-waves. This should be considered among the differentials of diffuse TWI in ECG of patients presenting to the emergency department (ED), especially when they have previous episodes of ventricular tachycardia (VT) or pacemaker implantation or Wolff-Parkinson-White syndrome. These TWIs are benign and do not require any treatment. However, it is of paramount importance for the emergency physician to differentiate it from ischemia-related T-wave changes. In the following case series, we report three cases of memory T-waves. Two of the cases had TWI in leads II, III, aVF, and V3 to V6 following reversion of VT. The other patient, with a VVI (Left ventricle paced, Left ventricle sensed, Inhibition to sensing) pacemaker, had memory T-waves in the ECG taken during normal sinus rhythm. In all the three patients, we considered memory T-waves to be the possible cause of TWI. The electrocardiographic diagnostic criteria for memory T-waves are positive T in lead aVL and positive/isoelectric T in the lead I; and precordial TWI >inferior TWI. These criteria are 92% sensitive and 100% specific. In the following case series, we also provide an algorithmic approach for patients with suspected memory T-waves in their 12-lead ECG when they present to the ED.
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Affiliation(s)
- R Gunaseelan
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - M Sasikumar
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - K Aswin
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - B Nithya
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - N Balamurugan
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - M Vivekanandan
- Department of Emergency Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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12
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Haq KT, Cao J, Tereshchenko LG. Characteristics of Cardiac Memory in Patients with Implanted Cardioverter-defibrillators: The Cardiac Memory with Implantable Cardioverter-defibrillator (CAMI) Study. J Innov Card Rhythm Manag 2021; 12:4395-4408. [PMID: 33654571 PMCID: PMC7909362 DOI: 10.19102/icrm.2021.120204] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/12/2020] [Indexed: 01/12/2023] Open
Abstract
This study sought to determine factors associated with cardiac memory (CM) in patients with implantable cardioverter-defibrillators (ICDs). Patients with structural heart disease [n = 20; mean age: 72.6 ± 11.6 years; 80% male; mean left ventricular ejection fraction (LVEF): 31.7 ± 7.6%; history of myocardial infarction in 75% and nonsustained ventricular tachycardia (NSVT) in 85%] and preserved atrioventricular conduction received dual-chamber ICDs for primary (80%) or secondary (20%) prevention. Standard 12-lead electrocardiograms were recorded in AAI and DDD modes before and after seven days of right ventricular (RV) pacing in DDD mode with a short atrioventricular delay. The direction (azimuth and elevation) and magnitude of spatial QRS, T, and spatial ventricular gradient vectors were measured before and after seven days of RV pacing. CM was quantified as the degree of alignment between QRSDDD-7 and TAAI-7 vectors (QRSDDD-7 –TAAI-7 angle). Circular statistics and mixed models with a random slope and intercept were adjusted for changes in cardiac activation, LVEF, known risk factors, and the use of medications known to affect CM occurring on days 1 through 7. The QRSDDD-7–TAAI-7 angle strongly correlated (circular r = −0.972; p < 0.0001) with a TAAI-7–TDDD-7 angle. In the mixed models, CM-T azimuth changes [+132° (95% confidence interval (CI): 80°–184°); p < 0.0001] were counteracted by the history of MI [−180° (95% CI: −320° to −40°); p = 0.011] and female sex [−162° (95% CI: −268° to −55°); p = 0.003]. A CM-T area increase [+15 (95% CI: 6–24) mV*ms; p < 0.0001] was amplified by NSVT history [+27 (95% CI: 4–46) mV*ms; p = 0.007]. These findings suggest that preexistent electrical remodeling affects CM in response to RV pacing, that CM exhibits saturation behavior, and that women reach CM saturation more easily than men.
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Affiliation(s)
- Kazi T Haq
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jian Cao
- Medtronic, Inc., Minneapolis, MN, USA
| | - Larisa G Tereshchenko
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
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13
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Gatzoulis KA, Tsiachris D, Arsenos P, Antoniou CK, Dilaveris P, Sideris S, Kanoupakis E, Simantirakis E, Korantzopoulos P, Goudevenos I, Flevari P, Iliodromitis E, Sideris A, Vassilikos V, Fragakis N, Trachanas K, Vernardos M, Konstantinou I, Tsimos K, Xenogiannis I, Vlachos K, Saplaouras A, Triantafyllou K, Kallikazaros I, Tousoulis D. Arrhythmic risk stratification in post-myocardial infarction patients with preserved ejection fraction: the PRESERVE EF study. Eur Heart J 2020; 40:2940-2949. [PMID: 31049557 PMCID: PMC6748724 DOI: 10.1093/eurheartj/ehz260] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 12/26/2018] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018 ![]()
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Affiliation(s)
- Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tsiachris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Skevos Sideris
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Emmanuel Kanoupakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Emmanouil Simantirakis
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Panagiotis Korantzopoulos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Ioannis Goudevenos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Panagiota Flevari
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Efstathios Iliodromitis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Antonios Sideris
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Vassilios Vassilikos
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Nikolaos Fragakis
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Konstantinos Trachanas
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Michail Vernardos
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Ioannis Konstantinou
- Department of Cardiology, University Hospital of Heraklion, University of Crete, Panepistimiou street, Heraklion, Crete, Greece
| | - Konstantinos Tsimos
- First Cardiology Division, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos avenue, Ioannina, Epirus, Greece
| | - Iosif Xenogiannis
- Second Cardiology Department, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini street, Chaidari, Attica, Greece
| | - Konstantinos Vlachos
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Athanasios Saplaouras
- Second State Cardiology Department, Evangelismos Hospital, 45-47 Ipsilantou street, Athens, Attica, Greece
| | - Konstantinos Triantafyllou
- Third Cardiology Department, Aristotle University Medical School, Hippokrateion Hospital, 49 Konstantinoupoleos street, Thessaloniki, Macedonia, Greece
| | - Ioannis Kallikazaros
- State Department of Cardiology, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion Hospital, 114 Vasilissis Sofias avenue, Athens, Attica, Greece
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14
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Kichloo A, Haji AQ, Kanjwal K. Cardiac memory presenting as ST elevations following premature ventricular complex ablation. HeartRhythm Case Rep 2020; 7:52-55. [PMID: 33505856 PMCID: PMC7813796 DOI: 10.1016/j.hrcr.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center, Watertown, New York
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan
| | - Abdul Qadir Haji
- Department of Cardiology, Martinsburg VA Medical Center, Martinsburg, West Virginia
| | - Khalil Kanjwal
- Department of Electrophysiology, McLaren Greater Lansing Hospital, Lansing, Michigan
- Address reprint requests and correspondence: Dr Khalil Kanjwal, Clinical Associate Professor of Medicine, Michigan State University, McLaren Greater Lansing Hospital, Lansing, MI 48901.
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15
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Polcwiartek C, Friedman DJ, Emerek K, Graff C, Sørensen PL, Kisslo J, Loring Z, Hansen SM, Kragholm K, Tayal B, Jensen SE, Søgaard P, Torp-Pedersen C, Atwater BD. Concomitant changes in ventricular depolarization and repolarization and long-term outcomes of biventricular pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1333-1343. [PMID: 32901967 DOI: 10.1111/pace.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Biventricular (BiV) pacing increases transmural repolarization heterogeneity due to epicardial to endocardial conduction from the left ventricular (LV) lead. However, limited evidence is available on concomitant changes in ventricular depolarization and repolarization and long-term outcomes of BiV pacing. Therefore, we investigated associations of BiV pacing-induced concomitant changes in ventricular depolarization and repolarization with mortality (i.e., LV assist device, heart transplantation, or all-cause mortality) and sustained ventricular arrhythmia endpoints. METHODS Consecutive BiV-defibrillator recipients with digital preimplantation and postimplantation electrocardiograms recorded between 2006 and 2015 at Duke University Medical Center were included. We calculated changes in QRS duration and corrected JT (JTc) interval and split them by median values. For simplicity, these variables were named QRSdecreased (≤ -12 ms), QRSincreased (> -12 ms), JTcdecreased (≤22 ms), and JTcincreased (> 22 ms) and subsequently used to construct four mutually exclusive groups. RESULTS We included 528 patients (median age, 68 years; male, 69%). No correlation between changes in QRS duration and JTc interval was observed (P = .295). Compared to QRSdecreased /JTcincreased , increased risk of the composite mortality endpoint was associated with QRSdecreased /JTcdecreased (hazard ratio [HR] = 1.62; 95% confidence interval [CI] = 1.09-2.43), QRSincreased /JTcdecreased (HR = 1.86; 95% CI = 1.27-2.71), and QRSincreased /JTcincreased (HR = 2.25; 95% CI = 1.52-3.35). No QRS/JTc group was associated with excess sustained ventricular arrhythmia risk (P = .400). CONCLUSION Among BiV-defibrillator recipients, QRSdecreased /JTcincreased was associated with the most favorable long-term survival free of LV assist device, heart transplantation, and sustained ventricular arrhythmias. Our findings suggest that improved electrical resynchronization may be achieved by assessing concomitant changes in ventricular depolarization and repolarization.
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Affiliation(s)
- Christoffer Polcwiartek
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, Connecticut
| | - Kasper Emerek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter L Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Joseph Kisslo
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Zak Loring
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Steen M Hansen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Svend E Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology and Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
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16
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Siroky GP, Keller S, Suri R. In memory of tachycardia: A wide complex tachycardia in a young male. J Arrhythm 2020; 36:801-803. [PMID: 32782661 PMCID: PMC7411235 DOI: 10.1002/joa3.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/24/2022] Open
Abstract
We present a case of a 24-year-old male with palpitations and a wide complex tachycardia. Baseline electrocardiogram (ECG) after termination of tachycardia demonstrates a normal rhythm but with inferior/anterolateral T-wave inversions (TWIs). Electrophysiologic study confirmed the diagnosis of posterior fascicular ventricular tachycardia successfully terminated by anatomic ablation of the left posterior fascicle. TWIs on the patient's baseline ECG were consistent with cardiac memory.
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Affiliation(s)
- Gregory P. Siroky
- Department of CardiologyDivision of ElectrophysiologyMount Sinai MorningsideIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Seth Keller
- Department of CardiologyDivision of ElectrophysiologyMount Sinai MorningsideIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Ranjit Suri
- Department of CardiologyDivision of ElectrophysiologyMount Sinai MorningsideIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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17
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Affiliation(s)
- Dinkar Bhasin
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Praveen Gupta
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Anunay Gupta
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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18
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Polito SC, Giordano JA, Cooper BL. Cardiac Memory-induced T-wave Inversions. Clin Pract Cases Emerg Med 2020; 4:181-184. [PMID: 32426667 PMCID: PMC7219993 DOI: 10.5811/cpcem.2020.1.45527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Cardiac memory refers to T-wave inversions that result when normal ventricular activation resumes following a period of abnormal ventricular activation. Case Report We present a case of a 29-year-old man with a pacemaker who presented with new, deep symmetric T-wave inversions caused by cardiac memory. Discussion Abnormal ventricular activation is most commonly induced by ventricular pacing but can also occur in the setting of transient left bundle branch blocks, ventricular tachycardia, and intermittent ventricular pre-excitation. Conclusion Recognition of this phenomenon may help to reduce unnecessary admissions, cardiac testing, and cardiac catheterizations.
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Affiliation(s)
- Sara C Polito
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, Texas
| | - Jonathan A Giordano
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, Texas
| | - Benjamin L Cooper
- McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, Texas
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19
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Abstract
Cardiac memory (CM) is a commonly unrecognized entity in which electrocardiograph (EKG) changes demonstrate T wave inversions (TWI) that appear consistent with ischemia. Inability to recognize and distinguish CM from actual ischemia can be a burden for both patients and hospitals, leading to unnecessary hospital admission, cardiac testing, and cardiac catheterization. Simple EKG analysis and meticulous interpretation of T-wave axis and morphology can help differentiate between the two. We present a case with such a dilemma, and an overview literature and physiology behind this entity.
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Affiliation(s)
- Rastko Rakočević
- Internal Medicine, University Hospital - Rutgers New Jersey Medical School, Newark, USA.,Pulmonary and Critical Care Medicine, University of Southern California, Los Angeles, USA
| | - Renjit Thomas
- Cardiology, University Hospital - Rutgers New Jersey Medical School, Newark, USA
| | - Ralph G Oriscello
- Cardiology/Critical Care, Veterans Affairs (VA) East Orange/Rutgers New Jersey Medical School, East Orange, USA
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20
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Suran MCB, Margulescu AD, Bruja R, Siliste C, Vinereanu D. Surface ECG criteria can discriminate post-septal pacing cardiac memory from ischemic T wave inversions. J Electrocardiol 2020; 58:10-17. [PMID: 31678715 DOI: 10.1016/j.jelectrocard.2019.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Cardiac memory (CM) refers to transient T wave changes that appear after cessation of a period of abnormal ventricular activation, such as right ventricular (RV) pacing. ECG criteria for differentiating post-pacing CM from ischemia-induced T wave changes were previously published only for apical, but not for septal RV pacing. AIM To find ECG criteria for discriminating post-septal pacing CM from ischemic T wave inversions. METHODS ECGs were analyzed in 2 groups: CM (n = 23) and ischemia (n = 26). CM was induced by 2 weeks of DDD pacing with a short AV delay. Ischemic patients were grouped by culprit vessel: left anterior descending (LAD), circumflex (Cx), right coronary artery (RCA). RESULTS CM was visible on the ECG after 1 week of ventricular pacing, started to disappear in <1 week after pacing cessation and was completely reversible within 4 weeks of pacing cessation. T wave axis differed between CM (75.8 ± 18.5°) and Cx (-25.2 ± 25.5°, p < 0.01) and RCA (-18.3 ± 18.9°, p < 0.01) groups, but not compared to LAD group (96.4 ± 65.0°, p = 0.17). The combination of (1) positive T wave in aVF; and (2) (i) T wave amplitude in aVF ≥ the absolute value of the most negative precordial T wave, or (ii) positive T wave in V5 and positive or isoelectric T wave in lead I identified CM from all ischemia with a sensitivity of 91% and a specificity of 92%. CONCLUSION ECG criteria can discriminate post-septal RV pacing CM from ischemic changes with high sensitivity and specificity.
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Affiliation(s)
- Maria-Claudia-Berenice Suran
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania
| | - Andrei-Dumitru Margulescu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania; Department of Cardiology, Morriston Hospital NHS Trust, Swansea, United Kingdom
| | - Ramona Bruja
- Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania
| | - Calin Siliste
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania.
| | - Dragos Vinereanu
- University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania; Department of Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Romania
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21
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Siontis KC, Wen S, Asirvatham SJ. Cardiac memory for the clinical electrophysiologist. J Cardiovasc Electrophysiol 2019; 30:2140-2143. [DOI: 10.1111/jce.14134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/08/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | - Songnan Wen
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
| | - Samuel J. Asirvatham
- Department of Cardiovascular DiseasesMayo ClinicRochester Minnesota
- Department of Pediatrics and Adolescent MedicineMayo ClinicRochester Minnesota
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22
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Grimm W, Luck K, Greene B, Parahuleva M. [Cardiac memory following pacemaker implantation]. Herzschrittmacherther Elektrophysiol 2019; 30:404-408. [PMID: 31562545 DOI: 10.1007/s00399-019-00646-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although T wave inversions due to cardiac memory were described already 50 years ago, little is known about the prevalence and about clinical predictors of this phenomenon. METHODS After exclusion of 238 patients due to bundle branch block or pacemaker dependency, a total of 325 consecutive patients were enrolled in this study during routine outpatient control of their pacemaker. A 12-lead standard ECG was obtained in all patients during transient inhibition of pacing therapy. RESULTS Cardiac memory could be documented in 115 of 325 patients (35%) and showed a strong association with the amount of ventricular stimulation. The prevalence of cardiac memory was 9% in patients with ≤25% ventricular stimulation and 86% in patients with ≥75% ventricular stimulation. DISCUSSION Cardiac memory was observed in one third of patients following pacemaker implantation. The prevalence of cardiac memory in the ECG with intrinsic rhythm is above 80% in patients with frequent ventricular stimulation. Cardiac memory due to ventricular stimulation is benign and should not be confused with similar T wave inversions due to acute coronary syndrome, severe left ventricular hypertrophy, or myocarditis.
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Affiliation(s)
- Wolfram Grimm
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland.
| | - Kathrin Luck
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - Brandon Greene
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps Universität Marburg., Marburg, Deutschland
| | - Mariana Parahuleva
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland
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23
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Sakamoto Y, Inden Y, Okamoto H, Mamiya K, Tomomatsu T, Fujii A, Yanagisawa S, Shibata R, Hirai M, Murohara T. T-wave changes of cardiac memory caused by frequent premature ventricular contractions originating from the right ventricular outflow tract. J Cardiovasc Electrophysiol 2019; 30:1549-1556. [PMID: 31157487 DOI: 10.1111/jce.14008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/16/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cardiac memory is recognized as altered T-waves when the sinus rhythm resumes after an abnormal myocardial activation period that recovers slowly over several weeks. The T-wave changes after ablation of frequent premature ventricular contractions (PVCs) as cardiac memory was not known. OBJECTIVE This study identified whether cardiac memory exists after successful ablation of PVCs from the right ventricular outflow tract (RVOT). METHODS We investigated 45 patients who underwent successful ablation of PVCs from RVOT and 10 patients who underwent unsuccessful ablation. We analyzed the amplitude of the T-wave, QT intervals, and QRST time-integral values of a 12-lead electrocardiogram before ablation and 1 day, 3 days, and 1 month after ablation. RESULTS In the successful ablation group, the amplitude of the T-wave and QRST time-integral values of lead II, III, aVR, aVL, and aVF significantly changed after ablation and gradually normalized within 1 month. In addition, if the number of pre-ablation PVCs was small, then the corresponding impact was also small. However, the greater the number of pre-ablation PVCs, the more prominent the changes. Significant changes were not observed in the unsuccessful ablation group. CONCLUSION When ablation of PVCs from RVOT was successful, primary T-wave changes because of cardiac memory and the gradual normalization of the amplitude of the T-wave were observed. No significant T-wave changes were detected after unsuccessful ablation.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroya Okamoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Mamiya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiro Tomomatsu
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Aya Fujii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rei Shibata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Hirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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24
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New T Wave Inversions Post Synchronized Cardioversion in a Patient With a Ventricular Pacemaker. Ann Emerg Med 2019; 73:627-630. [DOI: 10.1016/j.annemergmed.2018.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Simpson TF, Rahman S, Goldschlager N. Enhancing the Sgarbossa Criteria for the Diagnosis of ST Elevation Myocardial Infarction. JAMA Intern Med 2019; 179:564-566. [PMID: 30742197 DOI: 10.1001/jamainternmed.2018.7993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Salman Rahman
- Department of Medicine, University of California, San Francisco
| | - Nora Goldschlager
- Department of Medicine, University of California, San Francisco.,Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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26
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Brüggemann B, Eitel C, Graf T, Grimm K, Grimm W, Heeger C, Israel CW, Krauspe J, Kalantaryan V, Langer H, Luck K, Mischke K, Parahuleva M, Tilz RR, Touati S, Tribunyan S, Vogler J. [ECG signs of acute coronary syndrome]. Herzschrittmacherther Elektrophysiol 2019; 30:89-101. [PMID: 30825042 DOI: 10.1007/s00399-019-0613-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ben Brüggemann
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Charlotte Eitel
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Tobias Graf
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Kathrin Grimm
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, 35033, Marburg, Deutschland
| | - Wolfram Grimm
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, 35033, Marburg, Deutschland.
| | - Christian Heeger
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Carsten W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
| | - Jan Krauspe
- Klinik für Kardiologie, Nephrologie, Pneumologie, Angiologie und internistische Intensivmedizin, Leopoldina-Krankenhaus der Stadt Schweinfurt, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Deutschland
| | - Vazgen Kalantaryan
- Dept. of Medicine - Division of Cardiology, Medical Center Shengavit, Manandyan 9, 0006, Yerevan, Armenien.
| | - Harald Langer
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Kathrin Luck
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, 35033, Marburg, Deutschland
| | - Karl Mischke
- Klinik für Kardiologie, Nephrologie, Pneumologie, Angiologie und internistische Intensivmedizin, Leopoldina-Krankenhaus der Stadt Schweinfurt, Gustav-Adolf-Str. 8, 97422, Schweinfurt, Deutschland.
| | - Marianna Parahuleva
- Universitätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, 35033, Marburg, Deutschland
| | - Roland Richard Tilz
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland. .,Universitäres Herzzentrum Lübeck, Medizinische Klinik II - Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland.
| | - Soumia Touati
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Sona Tribunyan
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland
| | - Julia Vogler
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
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Goeddel LA, Hopkins AN, Fernando RJ, Núñez-Gil IJ, Ramakrishna H. Analysis of the 4th Universal Definition of Myocardial Infarction-Key Concepts and Perioperative Implications. J Cardiothorac Vasc Anesth 2019; 33:3486-3495. [PMID: 30738751 DOI: 10.1053/j.jvca.2019.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Amanda N Hopkins
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Rohesh J Fernando
- Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC
| | - Iván J Núñez-Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ.
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28
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Ibarrola M. Multiple myocardial bridges associated with left-ventricular dysfunction, intermittent left bundle branch block, and cardiac memory: A case report. Ann Noninvasive Electrocardiol 2018; 24:e12594. [PMID: 30117721 DOI: 10.1111/anec.12594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 11/28/2022] Open
Abstract
Myocardial bridges are a congenital anomaly in which a segment of the coronary artery takes a "tunneled" intramuscular course. Few reports have associated myocardial bridges with left-ventricular dysfunction in patients with ischemia. Intermittent left bundle branch block is a conduction disturbance that has been described to be associated with myocardial bridges and cardiac memory. This study reports unusual associations of multiple myocardial bridges, angina, left-ventricular dysfunction, intermittent left bundle branch block, and cardiac memory.
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29
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Peck D, Al-Kaisey A. Cardiac memory: an under-recognised cause of deep T wave inversion in a patient presenting with chest pain. BMJ Case Rep 2018; 2018:bcr-2018-225476. [PMID: 30061136 DOI: 10.1136/bcr-2018-225476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
T wave inversion (TWI) has many differential diagnoses with acute myocardial ischaemia being the highest on the list of potential causes. Cardiac T wave memory is a benign, under-recognised and clinically important phenomenon seen after periods of altered ventricular conduction. After normal ventricular conduction is restored, the T wave 'remembers' and mirrors the direction of the wide QRS complex. Therefore, negative T waves are seen in leads that had negative wide QRS complexes. We describe the case of a 60-year-old truck driver with chest pain, deep TWI and traditional cardiovascular risk factors. After ruling out significant myocardial ischaemia, it was crucial to determine the cause of his T wave changes to provide reassurance and provide commercial license medical clearance. While it is currently a diagnosis of exclusion, it remains an important clinical entity for clinicians to recognise to provide an explanation for certain T wave changes to avoid future unnecessary cardiac testing.
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Affiliation(s)
- Daniel Peck
- Department of Cardiology, Austin Heath, Heidelberg, Australia
| | - Ahmed Al-Kaisey
- Department of Cardiology, Austin Heath, Heidelberg, Australia
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30
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Nguyên UC, Verzaal NJ, van Nieuwenhoven FA, Vernooy K, Prinzen FW. Pathobiology of cardiac dyssynchrony and resynchronization therapy. Europace 2018; 20:1898-1909. [DOI: 10.1093/europace/euy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
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31
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di Matteo I, Crea P. Negative concordant T waves during paced ventricular rhythm: An honest enemy is better than a false friend. J Electrocardiol 2017; 50:507-509. [PMID: 28343654 DOI: 10.1016/j.jelectrocard.2017.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Irene di Matteo
- Interventional Cardiology Unit, De Gasperis CardioCenter -ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina.
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32
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Zhao YT, Huang YS, Wang L. Chest pain with giant global T wave inversions and extreme QT prolongation. Am J Emerg Med 2017; 35:664.e1-664.e2. [PMID: 27839841 DOI: 10.1016/j.ajem.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022] Open
Abstract
Negative T waves in electrocardiography have been widely studied. We presents a case of Wellens' syndrome which is a pattern of global inverted T waves with QT prolongation on ECG due to transient proximal LAD occlusion and pointed out other differential diagnosis.
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Affiliation(s)
- Yun-Tao Zhao
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan road, Beijing 100049, People's Republic of China.
| | - Yen Shu Huang
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan road, Beijing 100049, People's Republic of China
| | - Lei Wang
- Department of Cardiology, Aerospace Center Hospital, 15 Yuquan road, Beijing 100049, People's Republic of China
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33
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Post-pacemaker T-wave Inversions: Cardiac Memory. Am J Med 2016; 129:170-2. [PMID: 26440583 PMCID: PMC4995449 DOI: 10.1016/j.amjmed.2015.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/22/2022]
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