Cardiac memory in patients with intermittent Wolff-Parkinson-White syndrome

Clinical Dilemma - Cardiac Memory vs Myocardial Ischemia

“…CM is persistence of TWI developed after a period of abnormal ventricular activation once normal ventricular activation is restored [1][2][3]. Abnormal ventricular activation that precedes CM is often due to artificial pacemaker activity but also intrinsic ventricular ectopic focus, like intermittent left bundle branch block, Wolff-Parkinson-White (WPW), ventricular tachycardia [2,[4][5][6][7][8]. It was described that the T-wave axis during the CM has the same direction as QRS axis during the abnormal ventricular activation that caused CM (Figure 3, red arrows) [3].…”

T-Wave Inversion in Young Female

“…3 In the context of WPW syndrome, previous studies have shown that TWI is next to abnormal ventricular activation sequences, both overt WPW syndrome and concealed connections or intermittent WPW, the latter identified using the QRST isointegral maps. 4 Similarly, the T-wave axis after ablation is related to the preexisting QRS complex, previous abnormal ventricular activation sequence, and location of the accessory pathway, regardless of the degree of preexcitation. In addition, the magnitude of the QRS-T angle is related to changes in the QRS axis due to ablation, normalizing during weeks or months associated with progressive cardiac remodeling.…”

Chest Pain and T-Wave Inversions in a 56-Year-Old Man

“…Additionally, the loss of preexcitation in this case is associated with the development of T-wave inversions (TWIs), a form of cardiac memory. 1 Cardiac memory refers to persistent T-wave changes on the ECG usually seen on the transition from a wide QRS rhythm to a normal QRS duration; these T-wave changes eventually normalize but can persist from weeks to >1 month in some cases. In cases of cardiac memory, the abnormal T-wave of the narrow-complex QRS during sinus rhythm follows the same direction as the QRS complex during the preceding wide QRS rhythm.…”