T waves are independently generated in both right and left ventricles: the clinically recorded T is a summation of two separate repolarizations, and is thus always biventricular.
The T-wave of the electrocardiogram (ECG) is generated both from the left and the right ventricles of the heart. Each ventricle may produce a normal, an "ischemic", or a "secondary" T-wave, depending on segmental perfusion, intraventricular pressure, or QRS complex duration. The direction of the T-wave is determined by the particular inward rectifier potassium channels recruited by various layers and segments in the two ventricles. The observed T-wave in the clinical ECG is the summation of the left and right ventricular T waves, and is thus biventricular. Clinical observations in right bundle branch block (RBBB) and in right ventricular hypertensive states such as pulmonary embolism suggest that many ECG's interpreted as inferior or anterior left ventricular ischemia are in fact examples of abnormal potassium channel recruitment in the right ventricle. Consideration of the right ventricular component of the T-wave in every electrocardiographic interpretation improves diagnostic understanding and accuracy, as the possible right ventricular origin of observed anterior or superior T waves will not be overlooked.
Hoffman
Irwin
I
Lovelace Medical Center, S.E., Albuquerque, NM 87108, USA. irw.hoffman@stvin.org
D004562:Electrocardiography / Q000379:methods*; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*