Key result
Electrocardiographic diagnostic criteria for memory T-waves (positive T in aVL, positive/isoelectric T in lead I, and precordial TWI > inferior TWI) are 92% sensitive and 100% specific.
Why the study?
Memory T-waves are a benign cause of diffuse T-wave inversion that emergency physicians must differentiate from ischemia-related T-wave changes.
How can memory T-waves be differentiated from ischemia-related T-wave changes in patients presenting to the emergency department with diffuse T-wave inversion?
Case Report (n=3)
How can memory T-waves be differentiated from ischemia-related T-wave changes in patients presenting to the emergency department with diffuse T-wave inversion?
Memory T-waves are a benign cause of diffuse T-wave inversion that can be differentiated from ischemia using specific ECG criteria, preventing unnecessary interventions.
May aid ED differentiation of memory T-waves from ischemia; leaves open prospective validation before adoption.
One of the rare causes of diffuse T-wave inversion (TWI) in electrocardiogram (ECG) is memory T-waves. This should be considered among the differentials of diffuse TWI in ECG of patients presenting to the emergency department (ED), especially when they have previous episodes of ventricular tachycardia (VT) or pacemaker implantation or Wolff-Parkinson-White syndrome. These TWIs are benign and do not require any treatment. However, it is of paramount importance for the emergency physician to differentiate it from ischemia-related T-wave changes. In the following case series, we report three cases of memory T-waves. Two of the cases had TWI in leads II, III, aVF, and V3 to V6 following reversion of VT. The other patient, with a VVI (Left ventricle paced, Left ventricle sensed, Inhibition to sensing) pacemaker, had memory T-waves in the ECG taken during normal sinus rhythm. In all the three patients, we considered memory T-waves to be the possible cause of TWI. The electrocardiographic diagnostic criteria for memory T-waves are positive T in lead aVL and positive/isoelectric T in the lead I; and precordial TWI >inferior TWI. These criteria are 92% sensitive and 100% specific. In the following case series, we also provide an algorithmic approach for patients with suspected memory T-waves in their 12-lead ECG when they present to the ED.
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Gunaseelan et al. (2020) conducted a case report in Diffuse T-wave inversion (Memory T-waves) (n=3). Electrocardiographic diagnostic criteria for memory T-waves was evaluated on Sensitivity and specificity of ECG diagnostic criteria for memory T-waves. Electrocardiographic diagnostic criteria for memory T-waves (positive T in aVL, positive/isoelectric T in lead I, and precordial TWI > inferior TWI) are 92% sensitive and 100% specific.
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