The enigmatic sixth wave of the electrocardiogram: the U wave.
The U wave is the last, inconstant, smallest, rounded and upward deflection of the electrocardiogram. Controversial in origin, it is sometimes seen following the T wave with the TU junction along the baseline or fused with it and before P of the following cycle on the TP segment. In this review we will study its temporal location related to monophasic action potential, cardiac cycle and heart sounds, polarity, voltage or amplitude, frequency and shapecontour. We will analyze the clinical significance of negative, alternant, prominent U wave, and the difference between T wave with two peaks (T1-T2) and true U wave. Finally we will analyze the four main hypotheses about the source of U wave: repolarization of the intraventricular conducting system or Purkinje fibers system, delayed repolarization of the papillary muscles, afterpotentials caused by mechanoelectrical hypothesis or mechanoelectrical feedback, and the prolonged repolarization in the cells of the mid-myocardium ("M-cells").
Pérez Riera
Andrés Ricardo
AR
International VCG Investigators, ABC Faculty of Medicine, Foundation of ABC, Santo André, Brazil. riera@uol.com.br
Ferreira
Celso
C
Filho
Celso Ferreira
CF
Ferreira
Marcelo
M
Meneghini
Adriano
A
Uchida
Augusto Hiroshi
AH
Schapachnik
Edgardo
E
Dubner
Sergio
S
Zhang
Li
L
D000200:Action Potentials / Q000502:physiology*; D004562:Electrocardiography; D006321:Heart / Q000502:physiology*; D006801:Humans; D010210:Papillary Muscles / Q000502:physiology; D011690:Purkinje Fibers / Q000502:physiology*; D012032:Refractory Period, Electrophysiological / Q000502:physiology*