[Difficulties of persistent repolarization following normalization of the QRS wave in the Wolff-Parkinson-White...

The normalisation of the ventricular complex in the Wolff-Parkinson-White syndrome is often accompanied by changes in the repolarisation phase with a deep, symmetric and pointed T wave suggestive of coronary artery disease. In order to study this phenomenon we examined 29 cases of intermittent WPW, 13 of which had abnormalities of the normalised complex. Normalisation occurred spontaneously on 10 occasions, twice on exercise and once after Ajmaline. In the majority of cases (9/13) the preexcitation was a right (4 cases) or left (5 cases) posterior pathway and the T waves were abnormal in the posterior leads (II, III and AVF). In left lateral preexcitation the T waves were negative in lead 1 and AVL. The T wave changes seem to be related to the topography of the preexcitation pathway. They gradually disappeared in the 3 cases in which preexcitation had not recurred. The age of the patients (11 to 45 years, average 31 years) or normal coronary angiography, performed in 3 cases, excluded coronary pathology as did the close relationship between the topography of the preexcitation and the T wave changes and the gradual disappearance of the abnormalities in the cases where preexcitation did not recur. This phenomenon, related to abnormal ventricular activation, seems to be comparable to the changes in ventricular repolarisation observed on termination of ventricular pacing, on the regression of certain intermittent left bundle branch blocks and perhaps, in some cases, of the post-ventricular tachycardia syndrome.