Abstract
Background: Both duration and morphology of the T-wave are regarded important parameters describing repolarization of the ventricles. Conventionally, T-wave concordance is explained by an inverse relation between the time of depolarization (TD) and repolarization (TR). Little is known about T-wave morphology and TD-TR relations in patients with heart failure.
Methods: Electro-anatomic maps were obtained in the left (LV) and right ventricle (RV) and in the coronary sinus (CS) in patients with heart failure with narrow (nQRS, n = 8) and wide QRS complex with (LBBB, n = 15) and without left bundle branch block (non-LBBB, n = 7). TD and TR were determined from the thus acquired electrograms.
Results: In nQRS and non-LBBB patients, TD-TR relations had a slope between 0 and +1, indicating that repolarization followed the sequence of depolarization. In LBBB patients, repolarization occurred significantly earlier in the RV than in the LV, fitting with the idea that the discordant T-waves in LBBB are secondary to the abnormal depolarization sequence. However, the slopes of the TD-TR relations in the LV and CS were not significantly different from zero, indicating no major spatial gradient in LV repolarization, despite a considerable gradient in depolarization. Remarkable was also the large (similar to 100ms) transseptal gradient in repolarization. Values of the slopes of the TD-TR relation overlapped between the three patient groups, despite a difference in T-wave morphology between LBBB (all discordant) and nQRS patients (all flat/biphasic).
Conclusions: Discordant T-waves in LBBB patients are explained by interventricular dispersion in repolarization. T-wave morphology is determined by more factors than the TD-TR relation alone. (C) 2017 The Authors. Published by Elsevier Ireland Ltd.
Original language | English |
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Pages (from-to) | 270-276 |
Number of pages | 7 |
Journal | International Journal of Cardiology |
Volume | 241 |
DOIs | |
Publication status | Published - 15 Aug 2017 |
Keywords
- Heart failure
- Left bundle branch block
- Repolarization
- T-wave
- Electro-anatomic mapping
- BUNDLE-BRANCH BLOCK
- CARDIAC RESYNCHRONIZATION THERAPY
- ACTION-POTENTIAL DURATION
- VENTRICULAR REPOLARIZATION
- ACTIVATION
- MEMORY
- CANINE
- ARRHYTHMIAS
- MODULATION
- GRADIENTS