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European Heart Journal 1992 13(6):801-807;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Further evidence supporting the concept of T-wave memory: observation in patients having undergone high-energy direct current catheter ablation of the Wolff-Parkinson-White syndrome

J. E. POOLE and G. H. BARDY

Department of Medicine (Cardiology), University of Washington Seattle, Washington, U.S.A

Received 8 April 1991; accepted 2 August 1991.

Correspondence, Jeanne E.Poole, MD, FACC, Division of Cardiology, ZA-35, Harborview Medical Center, 325–9th Avenue, Seattle, WA 98104, U.S.A.

Abstract

Following successful high-energy direct current catheter ablation of posterior septal accessory pathways, serial T-wave changes were observed in seven patients with Wolff-Parkinson- White syndrome, but not in two patients with a concealed accessory bypass pathway. Following catheter ablation in the patients with Wolff-Parkinson-White syndrome, the previously upright T-waves in the inferior electrocariographic leads became inferiorly directed. Serial electrocardiograms following catheter ablation revealed slow regression of these T-wave changes over time. In contrast, in the two patients in whom a concealed accessory pathway was present, the T-waves prior to and following the procedure were upright. In these two patients, serial electrocardiograms showed no evolution of the T-wave vector over the same time period. Although a small rise in myocardial CK enzymes was observed, ischaemic injury in the area of catheter ablation could not be documented by post-procedure echocardiography, tomographic thallium scintigraphy, technetium pyrophosphate scinti-graphy or coronary angiography with left ventriculography. We conclude that the observed T-wave changes in the patients with Wolff-Parkinson-White syndrome may be a result of the change in depolarization sequence resulting from loss of pre-excitation, and that the time-dependent nature of these T-wave changes is consistent with the concept of T-wave ‘memory’.

Key Words: T-wave memory • catheter ablation • Wolff-Parkinson-White syndrome


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