This case report documents a rare finding of persistently bifid ("notched") U waves on ECG over 10 years, challenging traditional concepts of U-wave morphology.
Persistent bifid U waves may be benign without arrhythmia risk; leaves open their clinical significance pending larger studies.
Abnormal U waves (unduly larger or misshapen) are associated with several conditions such as hypokalemia, arrhythmias, cardiac ischemia, ventricular hypertrophy, and hypertension. Abnormal U waves have also been linked to certain cardiac medications, predominantly antiarrhythmics. However, mechanisms of U-wave-abnormality remains debated and perhaps elusive with the true U-wave relationship to T waves still being investigated. While there have indeed been reports of bifid ("notched") T waves, such comparably described U waves have escaped us thus far. We present a case of possibly bifid U waves that persisted over the course of 10 years in the setting of repeated negative Holter monitor findings and clinical absence of atrial tachyarrhythmias. We take this opportunity to briefly discuss common causes of "normal" and abnormal U waves.
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Ariyarajah et al. (2008) studied this question.
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