Key result
Novel ECG criteria distinguish cardiac memory from ischemic T-wave inversion with ~92% sensitivity and 100% specificity.
Why the study?
There are no established ECG criteria that adequately distinguish postpacing precordial T-wave inversion (cardiac memory) from ischemic precordial T-wave inversion.
Do specific ECG T-wave criteria differentiate postpacing cardiac memory from ischemic precordial T-wave inversion?
Observational (n=60)
Do specific ECG T-wave criteria differentiate postpacing cardiac memory from ischemic precordial T-wave inversion?
A specific combination of ECG T-wave criteria can highly accurately differentiate postpacing cardiac memory from ischemic precordial T-wave inversion.
May aid differentiation of postpacing cardiac memory from ischemic TWI; leaves open prospective validation before clinical adoption.
BACKGROUND: Postpacing precordial T-wave inversion (TWI), known as cardiac memory (CM), mimics ischemic precordial TWI, and there are no established ECG criteria that adequately distinguish between the two. On the basis of CM properties (postpacing sinus rhythm T vector approaching the direction of the paced QRS vector), we hypothesized that CM induced by right ventricular pacing would manifest a TWI pattern different from that of precordial ischemic TWI, thereby discriminating between the two. METHODS AND RESULTS: T-wave axis, polarity, and amplitude on a 12-lead ECG during sinus rhythm were compared between CM and ischemic patients. The CM group incorporated 13 patients who were paced in DDD mode with short atrioventricular delay for 1 week after elective pacemaker implantation. The ischemic group consisted of 47 patients with precordial TWI identified among 228 consecutive patients undergoing percutaneous coronary intervention for an acute coronary syndrome. The combination of (1) positive T(aVL), (2) positive or isoelectric T(I), and (3) maximal precordial TWI>TWI(III) was 92% sensitive and 100% specific for CM, discriminating it from ischemic precordial TWI. CONCLUSIONS: CM induced by right ventricular pacing results in a distinctive T-vector pattern that allows discrimination from ischemic precordial T-wave inversions regardless of the coronary artery involved.
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Shvilkin et al. (2005) conducted an observational in Precordial T-wave inversion (n=60). Right ventricular pacing-induced cardiac memory vs. Ischemic precordial T-wave inversion was evaluated on Discrimination of cardiac memory from ischemic precordial TWI using specific ECG criteria. The combination of positive T(aVL), positive or isoelectric T(I), and maximal precordial TWI>TWI(III) was 92% sensitive and 100% specific for discriminating cardiac memory from ischemic TWI.
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