Two undesired conditions resulting from T-Wave oversensing in two patients with hypertrophic cardiomyopathy: Inappropriate ICD shocks and pacemaker dysfunction

Abstract A 17-year-old boy with a history of dyspnea attacks and chest pain was referred to our paediatric cardiology department. Electrocardiogram at presentation showed T-wave inversion in the inferior leads. Cardiovascular magnetic resonance imaging revealed the rare diagnosis of apical hypertrophic cardiomyopathy with subendocardial late gadolinium enhancement, missed by echocardiography.

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Abstract 3265: A Comparison of Echocardiographic and Electrocardiographic Characteristics of Patients with Apical Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.116.suppl_16.ii_734-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Josepha Binder ◽

Brandon R Grossardt ◽

Christine Attenhofer Jost ◽

Kyle W Klarich ◽

Michael J Ackerman ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Ejection Fraction ◽

Left Ventricular ◽

Right Atrial ◽

Apical Hypertrophic Cardiomyopathy ◽

T Wave ◽

Atrial Enlargement ◽

Lv Ejection Fraction ◽

The Relationship ◽

T Waves

Background: Apical hypertrophic cardiomyopathy (apical HCM) is a less common subtype of HCM characterized by a focal thickening in the left ventricular apex. “Classic” ECG features have been described, however, apical HCM can persist for many years without detection. We investigated the relationship between ECG findings and echocardiographic morphometry in a large referral series of patients with apical HCM. Methods: We enumerated all patients diagnosed with apical HCM prior to Sept. 30, 2006 using the Mayo Clinic HCM database. We compared echocardiographic measures separately for patients with positive status for two ECG indices of left ventricular hypertrophy (LVH); the Sokolow-Lyon index and the Romhilt-Estes (RE) point-score. We also compared echocardiographic measurements in patients with and without negative T-waves in the precordial leads. Results: Apical HCM was detected in 177 patients (111 men and 68 women). Only 51% had positive Sokolow criteria and 51% had positive RE criteria. The agreement between Sokolow and RE status was high (agreement = 75.0%; kappa = 0.50; 95% CI = 0.38 – 0.62). In particular, Sokolow positive patients had increased LV ejection fraction (P = 0.02), and decreased LV end-systolic diameter (P = 0.03) compared with Sokolow negative patients. The prevalence of right atrial enlargement (47 vs. 28%; P = 0.02) and intracavity obstruction (22 vs. 8%; P = 0.01) were more common in Sokolow positive patients. Positive RE criteria was associated with a greater thickness of the basal septal and basal posterior walls (P = 0.001 and 0.02, respectively), and with a higher frequency of intracavity obstruction (21 vs. 9%; P = 0.04). Most patients (89%) exhibited at least one negative T-wave in the precordial leads; however, only 10% of patients had a negative T-wave of greater than 1.0 mV. We found that patients with an inverted T-wave larger than 0.4 mV (median) had a significantly increased LV ejection fraction (P = 0.03) compared with patients who had smaller or no negative T-waves. Conclusions: Among patients with apical HCM, nearly half do not have ECG evidence of LVH based on classic criteria and most do not have marked T-wave inversions. However, the majority did have at least a mild expression of negative T-waves.

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Reproducibility of T-wave morphology assessment in patients with hypertrophic cardiomyopathy and in healthy subjects

Computers in Cardiology 2001. Vol.28 (Cat. No.01CH37287) ◽

10.1109/cic.2001.977675 ◽

2002 ◽

Cited By ~ 1

Author(s):

Y. Gang ◽

K. Hnatkova ◽

X. Guo ◽

V. Batchvarov ◽

B. Acar ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Healthy Subjects ◽

T Wave ◽

Wave Morphology

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Relationship between cardiac mechanics evaluated by two-dimensional strain imaging and T-wave alternans in patients with hypertrophic cardiomyopathy

Menoufia Medical Journal ◽

10.4103/1110-2098.141725 ◽

2014 ◽

Vol 27 (2) ◽

pp. 447

Author(s):

AhmedA Attia ◽

HalaM Badran ◽

NaglaaF Ahmed

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Cardiac Mechanics ◽

Strain Imaging ◽

Two Dimensional ◽

T Wave ◽

T Wave Alternans

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Differences in the diagnostic value of various criteria of negative T waves for hypertrophic cardiomyopathy based on a molecular genetic diagnosis

Clinical Science ◽

10.1042/cs20060293 ◽

2007 ◽

Vol 112 (11) ◽

pp. 577-582 ◽

Cited By ~ 12

Author(s):

Tetsuo Konno ◽

Noboru Fujino ◽

Kenshi Hayashi ◽

Katsuharu Uchiyama ◽

Eiichi Masuta ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Molecular Genetic ◽

Genetic Diagnosis ◽

Diagnostic Value ◽

Left Ventricular ◽

Lower Sensitivity ◽

T Wave ◽

Accurate Definition ◽

Definition Of ◽

T Waves

Differences in the diagnostic value of a variety of definitions of negative T waves for HCM (hypertrophic cardiomyopathy) have not yet been clarified, resulting in a number of definitions being applied in previous studies. The aim of the present study was to determine the most accurate diagnostic definition of negative T waves for HCM in genotyped populations. Electrocardiographic and echocardiographic findings were analysed in 161 genotyped subjects (97 carriers and 64 non-carriers). We applied three different criteria that have been used in previous studies: Criterion 1, negative T wave >10 mm in depth in any leads; Criterion 2, negative T wave >3 mm in depth in at least two leads; and Criterion 3, negative T wave >1 mm in depth in at least two leads. Of the three criteria, Criterion 3 had the highest sensitivity (43% compared with 5 and 26% in Criterion 1 and Criterion 2 respectively; P<0.0001) and retained a specificity of 95%, resulting in the highest accuracy. In comparison with abnormal Q waves, negative T waves for Criterion 3 had a lower sensitivity in detecting carriers without LVH (left ventricular hypertrophy) (12.9% for negative T waves compared with 22.6% for abnormal Q waves). On the other hand, in detecting carriers with LVH, the sensitivity of negative T waves increased in a stepwise direction with the increasing extent of LVH (P<0.001), whereas there was less association between the sensitivity of abnormal Q waves and the extent of LVH. In conclusion, Criterion 3 for negative T waves may be the most accurate definition of HCM based on genetic diagnoses. Negative T waves may show different diagnostic value according to the different criteria and phenotypes in genotyped populations with HCM.

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