Postextrasystolic T wave changes

  The first (may be the second and the third) sinus beat(s) following a ventricular premature beat may show

      negative, flattened or augmented T waves.

  The cause is unknown.

  In the past, it was suggested that these postextrasystolic
T wave changes could be due to coronary artery

      disease or heart failure. Now, we know that this is not true.




Postextrasystolic U wave changes

  The first (may be the second and the third) sinus beat(s) following a ventricular premature beat may show

      prominent U waves.

  The cause is unknown.

 
In the presence of long QT interval, postextrasystolic augmentation of U wave suggests

     
increased risk of arrhythmia.

  Postextrasystolic
U wave augmentation is a well-recognized adverse prognostic sign in patients with

      the "pause-dependent long QT syndrome
".

      Patients with a prolonged QT interval showing bizarre TU complexes after PVCs are prone to

      the development of torsades de pointes and ventricular fibrillation.

 
In patients without the long QT syndrome, postextrasystolic U wave changes may be

      a specific marker of a tendency to the development of spontaneous ventricular arrhythmias.





T wave changes after cessation of tachycardia

  After cessation of a narrow QRS tachycardia, the first few sinus beats may show negative T waves.

      This finding does NOT necessarily indicate the presence of coronary artery disease.




References (with links to abstract and full-text articles)

  Pacing Clin Electrophysiol 2004;27(2):148-155.

  Heart 2002;88(6):633.

  Am J Cardiol 2000;85(2):261-263.

  J Am Coll Cardiol 1996;28(7):1746-1752.

  J Am Coll Cardiol 1995;25:1564-1575.

  Prog Cardiovasc Dis 1988;31(2):115-172.

  J Am Coll Cardiol 1983;2:806-817.

  Am Heart J 1981;102(4):658-663.

  Br Heart J 1977;39(4):371-374.





ECG 1. The ECG above belongs to a 59 years-old obese woman with hypertension and Diabetes Mellitus.
T wave of the first postextrasystolic beat is different than T waves of other sinus beats.

Click here for a more detailed ECG





ECG 2a. The ECG above belongs to a 64 years-old hypertensive man with normal ECHOcardiographic findings.
T wave of the first postextrasystolic beat is different than T waves of other sinus beats.

Click here for a more detailed ECG




ECG 2b. The ECG above belongs to the same man. It was recorded 11 months after the ECG 2a.
T waves of the first postextrasystolic beats are different than T waves of other sinus beats.

Click here for a more detailed ECG





ECG 3. The 3-channel Holter tracing above shows that
T wave of the first postextrasystolic beat,
is different than
T waves of other sinus beats.

Click here for a more detailed ECG





ECG 4. The ECG above is from a 76 years-old man with previous coronary artery bypass grafting surgery.
T waves of the first postextrasystolic beats are different than T waves of other sinus beats.

Click here for a more detailed ECG





ECG 5. The ECG above is from a man with subacute inferior myocardial infarction.
U wave of the first postextrasystolic beat is taller than U waves of other sinus beats.
The second beat from the left is an atrial premature beat. Its P wave is different than other P waves in lead II.

Click here for a more detailed ECG





ECG 6a. The ECG above belongs to a 70 years-old man with normal ECHOcardiographic findings.
T waves of the first postextrasystolic beats are different than T waves of other sinus beats.

Click here for a more detailed ECG




ECG 6b. The ECG above belongs to the same man. It was recorded
immediately after the ECG 6a.
This time,
T waves of the first postextrasystolic beats are NOT DIFFERENT than T waves of other sinus beats.

Click here for a more detailed ECG





ECG 7. The ECG above belongs to a 64 years-old hypertensive woman with coronary artery disease.
T wave of the first postextrasystolic beat is different than T waves of other sinus beats.

Click here for a more detailed ECG





ECG 8. A similar phenomenon may be seen after narrow QRS tachycardias.
The 3-channel Holter tracing above belongs to a 21 years-old man.
The first 7 beats are the last beats of an ectopic atrial tahycardia.
The first two postextrasystolic T waves following the cessation of tachycardia are different than T waves of other sinus beats.

Click here for a more detailed ECG




Page 1 - Page 2