The relation between local repolarization and T-wave morphology in heart failure patients

Francesco Maffessanti, Joris Wanten, Mark Potse, Francois Regoli, Maria Luce Caputo, Giulio Conte, Daniel Surder, Annekatrin Illner, Rolf Krause, Tiziano Moccetti, Angelo Auricchio, Frits W. Prinzen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

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 languageEnglish
Pages (from-to)270-276
Number of pages7
JournalInternational Journal of Cardiology
Volume241
DOIs
Publication statusPublished - 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

Cite this