Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Arrhythmia Service, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Heart Rhythm. 2022 Mar;19(3):459-465. doi: 10.1016/j.hrthm.2021.11.007. Epub 2021 Nov 9.
Altered ventricular depolarization due to manifest accessory pathway conduction (ie, Wolff-Parkinson-White syndrome) leads to repolarization abnormalities that persist after pathway ablation. The term T-wave memory (TWM) has been applied to these changes, as the postablation T-wave vector "remembers" the pre-excited QRS vector. In adults, these abnormalities can be misinterpreted as ischemia leading to unnecessary interventions. To date, no comprehensive studies have evaluated this phenomenon in the pediatric population.
The purpose of this study was to define TWM in the pediatric population, identify preablation risk factors, and delineate the timeline of recovery.
Pre- and postablation electrocardiograms (ECGs) in patients ≤25 years were analyzed over a 5-year period. Frontal plane QTc interval, T-wave axis, QRST angle, and T-wave inversions were used to identify patients with TWM. Univariate analysis was performed to determine the association of preablation ECG features with the outcome of TWM.
TWM was present in 42% of pediatric patients, with resolution occurring within 3 months of ablation. Preablation QRS axis <0° was a strong predictor of TWM (odds ratio [OR] 15.2; 95% confidence interval [CI] 5.7-40), followed by posteroseptal pathway location (right posteroseptal-OR 8.9; 95% CI 4.2-18.8; left posteroseptal-OR 6.1; 95% CI 1.7-22.3). The degree of pre-excitation had a modest association with the development of TWM. No adverse events were observed.
TWM is less common in children compared to adults, and normalization occurred within 3 months postablation. The most predictive features for the development of TWM include a leftward pre-excited QRS axis and posteroseptal pathway location.
由于显性旁路传导导致的心室去极化改变（即 Wolff-Parkinson-White 综合征）导致复极异常，这些异常在旁路消融后仍然存在。术语 T 波记忆（TWM）已被应用于这些变化，因为消融后的 T 波向量“记住”了预激的 QRS 向量。在成人中，这些异常可能被误诊为缺血，导致不必要的干预。迄今为止，尚无全面的研究评估这种现象在儿科人群中的表现。
本研究旨在定义儿科人群中的 TWM，确定消融前的危险因素，并描绘其恢复的时间进程。
在 5 年内分析了年龄≤25 岁的患者的消融前后心电图（ECG）。使用额面 QTc 间期、T 波轴、QRST 角和 T 波倒置来识别 TWM 患者。进行单变量分析以确定消融前 ECG 特征与 TWM 结果的关联。
42%的儿科患者存在 TWM，消融后 3 个月内恢复。消融前 QRS 轴<0°是 TWM 的强烈预测因素（优势比[OR] 15.2；95%置信区间[CI] 5.7-40），其次是间隔后部位（右侧间隔后-OR 8.9；95%CI 4.2-18.8；左侧间隔后-OR 6.1；95%CI 1.7-22.3）。预激的程度与 TWM 的发生有一定的关联。未观察到不良事件。
与成人相比，儿童的 TWM 较少见，且在消融后 3 个月内恢复正常。预测 TWM 发展的最具特征性的特征包括左向预激 QRS 轴和间隔后部位。
