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Europace Advance Access originally published online on August 8, 2007
Europace 2007 9(11):1093; doi:10.1093/europace/eum156
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© The European Society of Cardiology 2007. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

ELECTROCARDIOLOGY

Post-extrasystolic changes of the T wave in a patient with congestive heart failure

Velislav N. Batchvarov*, Abhay Bajpai and A. John Camm

Division of Cardiac and Vascular Sciences, St George's University of London, Cranmer Terrace, London SW17 0RE, UK

Manuscript submitted 30 May 2007. Accepted after revision 5 July 2007.

* Corresponding author. Tel: +44 208 725 5909; fax: +44 208 767 7141. Email address: vbatchva{at}sgul.ac.uk

We present a 12-lead resting electrocardiogram (25 mm/s, 10 mm/mV) recorded in a 58-year-old man with congestive heart failure (CHF) NYHA class III of unknown origin, which is probably alcohol-related (Figure, left panel). It shows sinus tachycardia, left atrial enlargement, prolonged QRS complex, non-specific T-wave changes and prolonged QTc (Bazett) interval of about 490 ms. Every third complex is a broad QRS complex, most probably a late ventricular ectopic or fusion beat.

On closer inspection, the T wave of each post-extrasystolic sinus complex differs from that of the immediately following pre-extrasystolic complex. This is visible when all pre- and post-extrasystolic sinus QRS-T complexes in lead V6 were reconstructed and superimposed and the QRS complexes aligned (right panel, only T waves are shown, arbitrary scale). There is no visible relationship between the T-wave changes and the duration of the pre- or post-extrasystolic intervals. There is no visible difference in the QT interval between the post- and pre-extrasystolic sinus complexes.

This is an example of post-extrasystolic T-wave changes. Changes in the T-wave amplitude, shape, or polarity of the sinus beats immediately following ventricular extrasystoles, which were first reported in 1915, are not infrequently observed in both cardiac patients and healthy individuals. Their mechanism is unknown, but it is considered to be related to cardiac memory, similar to the T-wave changes following intermittent ventricular pacing, left bundle branch block, or ventricular pre-excitation. The clinical significance of this form of ventricular electrical remodelling is unknown, apart from the link between post-extrasystolic T–U wave augmentation and torsades de pointes.


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  		Figure Left panel: Resting 12-lead electrocardiogram. Right panel: All pre- and post-extrasystolic sinus QRS-T complexes have been superimposed and aligned by the QRS complex. Only the T waves are shown, arbitrary scale. The post-extrasystolic T waves (thin lines) are visibly different from the pre-extrasystolic T waves (thick lines).

 

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