Further evidence supporting the concept of T-wave memory: observation in patients having undergone high-energy direct current catheter ablation of the Wolff-Parkinson-White syndrome.
Following successful high-energy direct current catheter ablation of posterior septal accessory pathways, serial T-wave changes were observed in seven patients with Wolff-Parkinson-White syndrome, but not in two patients with a concealed accessory bypass pathway. Following catheter ablation in the patients with Wolff-Parkinson-White syndrome, the previously upright T-waves in the inferior electrocardiographic leads became inferiorly directed. Serial electrocardiograms following catheter ablation revealed slow regression of these T-wave changes over time. In contrast, in the two patients in whom a concealed accessory pathway was present, the T-waves prior to and following the procedure were upright. In these two patients, serial electrocardiograms showed no evolution of the T-wave vector over the same time period. Although a small rise in myocardial CK enzymes was observed, ischaemic injury in the area of catheter ablation could not be documented by post-procedure echocardiography, tomographic thallium scintigraphy, technetium pyrophosphate scintigraphy or coronary angiography with left ventriculography. We conclude that the observed T-wave changes in the patients with Wolff-Parkinson-White syndrome may be a result of the change in depolarization sequence resulting from loss of pre-excitation, and that the time-dependent nature of these T-wave changes is consistent with the concept of T-wave 'memory'.
Poole
J E
JE
Department of Medicine (Cardiology), University of Washington, Seattle.
Bardy
G H
GH
D000328:Adult; D006328:Cardiac Catheterization; D003402:Creatine Kinase / Q000378:metabolism; D004562:Electrocardiography; D004564:Electrocoagulation; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008875:Middle Aged; D014927:Wolff-Parkinson-White Syndrome / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*
D007527:Isoenzymes; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase