Cardiac Memory after Radiofrequency Ablation of Accessory Pathways: The Post-ablation T Wave Does not Forget the Pre-excited QRS

Bengt Herweg, John Devens Fisher, Arzu Ilercil, Marta R. Martinez, Jay N. Gross, Soo G. Kim, Kevin J. Ferrick

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized. Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs. Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63%) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and ≤40° in 25/35 patients (71%). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = -0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location. Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.

Original languageEnglish (US)
Pages (from-to)263-272
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume3
Issue number3
DOIs
StatePublished - 1999

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Electrocardiography
Accessory Atrioventricular Bundle
Bundle-Branch Block
Transcription Factor AP-1
Lead

Keywords

  • Ablation
  • Cardiac memory
  • WPW syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac Memory after Radiofrequency Ablation of Accessory Pathways : The Post-ablation T Wave Does not Forget the Pre-excited QRS. / Herweg, Bengt; Fisher, John Devens; Ilercil, Arzu; Martinez, Marta R.; Gross, Jay N.; Kim, Soo G.; Ferrick, Kevin J.

In: Journal of Interventional Cardiac Electrophysiology, Vol. 3, No. 3, 1999, p. 263-272.

Research output: Contribution to journalArticle

@article{65776a895a3a468f9fbc5e70031503a0,
title = "Cardiac Memory after Radiofrequency Ablation of Accessory Pathways: The Post-ablation T Wave Does not Forget the Pre-excited QRS",
abstract = "Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized. Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs. Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63{\%}) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and ≤40° in 25/35 patients (71{\%}). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = -0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location. Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.",
keywords = "Ablation, Cardiac memory, WPW syndrome",
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T1 - Cardiac Memory after Radiofrequency Ablation of Accessory Pathways

T2 - The Post-ablation T Wave Does not Forget the Pre-excited QRS

AU - Herweg, Bengt

AU - Fisher, John Devens

AU - Ilercil, Arzu

AU - Martinez, Marta R.

AU - Gross, Jay N.

AU - Kim, Soo G.

AU - Ferrick, Kevin J.

PY - 1999

Y1 - 1999

N2 - Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized. Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs. Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63%) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and ≤40° in 25/35 patients (71%). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = -0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location. Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.

AB - Introduction: Normalization of the pre-excited QRS following ablation is accompanied by repolarization changes but their directional relationship to changes in ventricular activation has not been well characterized. Methods: Accordingly, we measured QRS and T wave vectors and QRS-T angles from 12 lead ECG recordings immediately before and after accessory pathway (AP) radiofrequency ablation in 100 consecutive patients. Patients with bundle branch block, intraventricular conduction defect or intermittent pre-excitation were excluded, leaving a study group of 45 patients: 35 with pre-excitation and 10 with concealed APs. Results: With AP ablation, changes occurred in the QRS and T wave vectors and QRS-T angles that were essentially equal and opposite, so that the newly normalized QRS complex and QRS vector were accompanied by a T wave whose vector approximated that of the pre-ablation QRS vector. This tended to maintain a large QRS-T angle: 72° ± 50° before, and 54° ± 34° after QRS normalization (p = NS). A QRS-T angle >40° was found before and after ablation in 22/35 patients (63%) with baseline pre-excitation; but never in patients with a concealed AP (p = 0.001). The angle between the pre-excited QRS and the post-ablation T wave was 35° ± 37°, and ≤40° in 25/35 patients (71%). The change in T wave axis with QRS normalization correlated in magnitude with the QRS-T angle before ablation (r = 0.73, p < 0.0001). The change in QRS axis correlated with the QRS-T angle after ablation (r = 0.37, p < 0.03). Shorter AP effective refractory periods (ERPs) correlated with wider QRS-T angles after ablation (r = -0.39, p < 0.03). The ECG leads manifesting these changes depend on AP location. Conclusion: T-wave changes after ablation of APs (1) are dependent on anterograde AP conduction at baseline and are not observed with concealed APs; (2) correlate in magnitude directly with the change in QRS axis and inversely with the anterograde AP-ERP; (3) are related to AP location. With termination of pre-excitation secondary repolarization changes immediately disappear and the post ablation T wave axis approximates that of the pre-excited QRS. Recognition of this sequence may prevent unnecessary clinical interventions.

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