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T-wave inversion: cardiac memory or myocardial ischemia?

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This case report highlights T-wave inversion (TwI) in atrial fibrillation, initially mistaken for ischemia. The findings were attributed to cardiac memory, a phenomenon where T waves track abnormal QRS complexes.

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Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Atrial fibrillation (AF) is a common arrhythmia.
  • T-wave inversion (TwI) on electrocardiograms can indicate myocardial ischemia.
  • Cardiac memory is a T-wave abnormality that can mimic ischemic changes.

Observation:

  • A 74-year-old male patient presented with atrial fibrillation during pacemaker interrogation.
  • Electrocardiogram revealed significant T-wave inversion (TwI) in the context of AF.
  • Initial workup for myocardial ischemia showed a perfusion defect, but cardiac catheterization revealed nonobstructive coronary artery disease.

Findings:

  • Persistent, albeit attenuated, TwI was noted on follow-up electrocardiograms.
  • The TwIs were ultimately attributed to cardiac memory, a phenomenon where T waves adapt to preceding abnormal QRS complexes.
  • Cardiac memory can be induced by arrhythmias like atrial fibrillation or ventricular pacing.

Implications:

  • Cardiac memory is an underrecognized cause of TwI that can be mistaken for ischemic heart disease.
  • Awareness of cardiac memory is crucial for accurate electrocardiogram interpretation in patients with arrhythmias.
  • This case underscores the importance of considering non-ischemic etiologies for TwI in the context of underlying cardiac conditions.