Repolarization abnormalities after catheter ablation of accessory atrioventricular connections with radiofrequency current

Steven J. Kalbfleisch, Joao Sousa, Rafel El-Atassi, Hugh Calkins, Jonathan Langberg, Fred Morady

Research output: Contribution to journalArticlepeer-review

Abstract

The purpose of this study was to evaluate the serial changes in T wave configuration in patients undergoing successful radiofrequency catheter ablation of accessory atrioventricular (AV) connections. Twenty-nine consecutive patients with overt pre-excitation and 16 patients with a concealed accessory atrioventricular (AV) connection were included. An electrocardiogram (ECG) was recorded before ablation and 15 min, 1 or 2 days and 1 and 3 months after ablation. Postablation T wave abnormalities occurred in 22 (76%) of the 29 patients who had overt pre-excitation but in none of the 16 patients with a concealed accessory AV connection. The T wave abnormalities were not related to myocardial necrosis or echocardiographic abnormalities. The ECG location and severity of T wave changes were dependent on the accessory AV connection location and degree of baseline pre-excitation, respectively. Fourteen of 19 patients with a posteriorly located AV connections (left, right or septal) had T wave inversion or flattening in the inferior leads and 3 patients had precordial T wave peaking. two patients with an anteroseptal AV accessory connection had both inferior T wave inversion or flattening and precordial T wave peaking. Among seven patients with a manifest left lateral accessory AV connection, two had lateral T wave inversion or flattening and two had precordial T wave peaking. There was 95% concordance between the directional change of the T wave after ablation and the direction of the delta wave on the baseline ECG. Follow-up ECGs demonstrated complete resolution of the T wave changes in a minority of patients in the 1st 1 to 2 days after ablation; by 3 months, complete or near complete resolution occurred in nearly all patients. It is concluded that transient repolarization abnormalities that mimic ischemia occur commonly after elimination of overt pre-excitation and are dependent on the direction of the delta wave and the degree of baseline pre-excitation. These repolarization abnormalities are not due to cardiac injury and may be explained by the presence of cardiac memory.

Original languageEnglish (US)
Pages (from-to)1761-1766
Number of pages6
JournalJournal of the American College of Cardiology
Volume18
Issue number7
DOIs
StatePublished - Dec 1991
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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