Heart Views

CASE REPORT
Year
: 2020  |  Volume : 21  |  Issue : 4  |  Page : 289--290

Giant negative T-waves as cardiac memory phenomenon following ablation of right-sided posteroseptal accessory pathway


Giacomo Mugnai, Stefano Cavedon, Cosimo Perrone, Claudio Bilato 
 Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy

Correspondence Address:
Dr. Giacomo Mugnai
Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza
Italy

Abstract

We present a paradigmatic example of “cardiac memory,” characterized by deep, giant, and negative T-waves in the inferior leads, after a successful ablation of a right-sided posteroseptal accessory pathway.



How to cite this article:
Mugnai G, Cavedon S, Perrone C, Bilato C. Giant negative T-waves as cardiac memory phenomenon following ablation of right-sided posteroseptal accessory pathway.Heart Views 2020;21:289-290


How to cite this URL:
Mugnai G, Cavedon S, Perrone C, Bilato C. Giant negative T-waves as cardiac memory phenomenon following ablation of right-sided posteroseptal accessory pathway. Heart Views [serial online] 2020 [cited 2021 Apr 20 ];21:289-290
Available from: https://www.heartviews.org/text.asp?2020/21/4/289/307035


Full Text



 Introduction



The “cardiac memory” is a phenomenon originally described after ventricular pacing[1] and also after ventricular tachycardia,[2] intermittent bundle branch block,[3] and following periods of preexcitation in patients with Wolff–Parkinson–White (WPW) syndrome.[4] This phenomenon is characterized by T-wave inversions occurring after a period of altered ventricular depolarization where the T-vector has the same direction as the vector of the previous altered QRS complex.[5] Previous studies showed that these repolarization abnormalities may occur after successful ablation of overt accessory pathways, mostly posteroseptal, remaining some weeks after the ablation procedure.

 Case Presentation



[Figure 1]a shows the electrocardiogram (ECG) of a 24-year-old boy with an overt preexcitation due to a right-sided posteroseptal accessory pathway (delta wave positive in I, II, and aVL, V2–V6 and negative in III, aVR, and V1). The patient was referred to our center because of recurrent episodes of palpitations. The accessory pathway was identified in the right posteroseptal portion of the right atrium, near the ostium of the coronary sinus, and a radiofrequency application successfully resulted in disappearance of the preexcitation and dissociation of ventriculo-atrial retroconduction. The ECG performed 20 h later still showed the absence of the prexcitation and also deep, giant, negative T-waves in II, III, and aVF [Figure 1]b, secondary to “cardiac memory.”{Figure 1}

 Discussion



Previous studies reported that cardiac memory developed in 47%–100% of cases following ablation of overt WPW;[5] these postablation abnormalities are predominantly reflected in the horizontal plane in those patients with overt left-sided accessory pathways and in the frontal plane in those with right-sided accessory pathways, as in our case. The resumption of this phenomenon after ablation commonly occurs within 3 months, but 10% of available ECG shows the persistence of cardiac memory beyond this period.[5]

As radiofrequency ablation has become a cornerstone for the treatment of WPW syndrome, it is crucial for physicians to be aware of these ECG changes which can persist for several months. As in our case, T-wave inversions following radiofrequency ablation of posterospeptal accessory pathways are located in the inferior leads and might be misinterpreted as a sign of inferior wall ischemia. When these patients come to the emergency room for a chest pain, it might be difficult to differentiate between cardiac memory and myocardial ischemia. As shown in our case, when the repolarization abnormalities of cardiac memory are represented by deep, giant, negative T-waves, this might resemble ischemia. Although the majority of patients with WPW syndrome are young and mostly in a clinical health status and therefore unlikely to suffer from ischemic heart disease, Aunes-Jansson[5] reported that 20 of 125 (16%) patients in their study were more than 50 years old and the oldest 76 years.

 Conclusion



Our case represents a paradigmatic example of cardiac memory with unexpectedly giant negative T-waves following catheter ablation of a right-sided posteroseptal accessory pathway.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Chatterjee K, Harris AM, Davies JG, Leatham A. T-wave changes after artificial pacing. Lancet 1969;1:759-60.
2Kernohan RJ. Post-paroxysmal tachycardia syndrome. Br Heart J 1969;31:803-6.
3Engel TR, Meister SG, Frankl WS. Postextrasystolic T wave changes and angiographic coronary disease. Br Heart J 1977;39:371-4.
4Nicolai P, Medvedowsky JL, Delaage M, Barnay C, Blache E, Pisapia A. Wolff–Parkinson–White syndrome: T wave abnormalities during normal pathway conduction. J Electrocardiol 1981;14:295-300.
5Aunes-Jansson M, Wecke L, Lurje L, Bergfeldt L, Edvardsson N. T wave inversions following ablation of 125 posteroseptal accessory pathways. Int J Cardiol 2006;106:75-81.