Search

The article presents a case report of the Chatterjee phenomenon after implantation of a pacemaker in a patient with heart failure with preserved ejection fraction. During hospitalization in a specialized cardiology hospital, the patient's electrocardiogram (ECG) showed atrial fibrillation (AF) with a ventricular rate of 49 bpm, ST segment depression of 1 mm in I, II, V4-V6 leads. Taking into account the data of 24-hour ECG monitoring (pauses up to 5,2 seconds with AF) and Stokes-Adams syndrome equivalents, a decision was made to implant a single-chamber pacemaker. Immediately after the pacemaker implantation, AF was registered on the ECG with a pacemaker VVI mode of 60 pulses/min. On the second day after intervention, the pacemaker was reprogrammed in the form of reducing the minimum pacing rate from 60 to 45 pulses/min. On the third day after pacemaker implantation, altered terminal ventricular complex part was detected in the form of negative T waves in I, II, III, aVF, V2-V6 leads, as well as ST segment depression in V3-V6 to 1,5 mm. Differential diagnosis of the identified abnormalities with other clinical conditions accompanied by impaired repolarization processes according to ECG data was carried out. In dynamics, normalization of the ECG picture after 2,5 months was demonstrated.

One of the rare causes of diffuse T-wave inversion (TWI) in electrocardiogram (ECG) is memory T-waves. This should be considered among the differentials of diffuse TWI in ECG of patients presenting to the emergency department (ED), especially when they have previous episodes of ventricular tachycardia (VT) or pacemaker implantation or Wolff-Parkinson-White syndrome. These TWIs are benign and do not require any treatment. However, it is of paramount importance for the emergency physician to differentiate it from ischemia-related T-wave changes. In the following case series, we report three cases of memory T-waves. Two of the cases had TWI in leads II, III, aVF, and V3 to V6 following reversion of VT. The other patient, with a? VVI (Left ventricle paced, Left ventricle sensed, Inhibition to sensing) pacemaker, had memory T-waves in the ECG taken during normal sinus rhythm. In all the three patients, we considered memory T-waves to be the possible cause of TWI. The electrocardiographic diagnostic criteria for memory T-waves are positive T in lead aVL and positive/isoelectric T in the lead I; and precordial TWI >inferior TWI. These criteria are 92% sensitive and 100% specific. In the following case series, we also provide an algorithmic approach for patients with suspected memory T-waves in their 12-lead ECG when they present to the ED.

One of the rare causes of diffuse T-wave inversion (TWI) in electrocardiogram (ECG) is memory T-waves. This should be considered among the differentials of diffuse TWI in ECG of patients presenting to the emergency department (ED), especially when they have previous episodes of ventricular tachycardia (VT) or pacemaker implantation or Wolff-Parkinson-White syndrome. These TWIs are benign and do not require any treatment. However, it is of paramount importance for the emergency physician to differentiate it from ischemia-related T-wave changes. In the following case series, we report three cases of memory T-waves. Two of the cases had TWI in leads II, III, aVF, and V3 to V6 following reversion of VT. The other patient, with a? VVI (Left ventricle paced, Left ventricle sensed, Inhibition to sensing) pacemaker, had memory T-waves in the ECG taken during normal sinus rhythm. In all the three patients, we considered memory T-waves to be the possible cause of TWI. The electrocardiographic diagnostic criteria for memory T-waves are positive T in lead aVL and positive/isoelectric T in the lead I; and precordial TWI >inferior TWI. These criteria are 92% sensitive and 100% specific. In the following case series, we also provide an algorithmic approach for patients with suspected memory T-waves in their 12-lead ECG when they present to the ED. [ABSTRACT FROM AUTHOR]

Background : Cardiac memory, also known as the Chatterjee phenomenon, is a poorly understood, under-recognized but important and benign cause of T-wave inversions. After a period of abnormal ventricular activation, such as ventricular pacing, intermittent left bundle branch block or pre-excitation, the heart 'remembers' and mirrors its repolarization in the direction of the previous QRS. It usually manifests as T-wave inversions that can linger up to weeks after the provocative event. Case summary : An 87-year-old man with extensive cardiovascular history and risk factors presented to the emergency department with shortness of breath and chest pain. An ECG taken on admission revealed deep widespread T wave inversions. Serial high sensitive cardiac troponin (hs-cTn) however remained negative (<10 ng/ml) with a negative D-dimer. Upon reviewing previous ECGs and the medical history, the patient was diagnosed with cardiac memory, which required no further treatment. Conclusion : Cardiac memory should be considered in any patient with a ventricular pacemaker that presents with narrow QRS rhythm and T-wave changes suggestive of ischemia. Although it remains a diagnosis of exclusion, recognizing this important clinical entity can prevent unnecessary admissions, expensive diagnostic tests and invasive procedures.