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The positive T wave [Anatol J Cardiol]
Anatol J Cardiol. 2007; 7(Suppl 1): 164-167

The positive T wave

Mark Potse1, Ruben Coronel2, Tobias Opthof2, Alain Vinet1
1Research Center, Hôpital du Sacré-Coeur, Montréal, Department of Physiology, Institute of Biomedical Engineering, Université de Montréal, Québec, Canada
2Department of Experimental Cardiology, Center for Heart Failure Research, Academic Medical Center, Amsterdam, The Netherlands

Objective: The instant of maximum slope (Tup) of the T wave in the unipolar electrogram is a well-established measure of repolarisation time (TR). Nevertheless, recent observations on positive T waves have caused a renewed debate. The purpose of this study was to elucidate the mechanism that leads to positive and negative T waves and to investigate which electrogram feature best predicts TR. Methods: We simulated propagating action potentials (AP) and electrograms with a bidomain reaction-diffusion model of the human heart including heterogeneous ion-channel properties. To explain positive T waves we compared results with those of a much simpler model, which predicts T waves from local and remote AP. Results: Repolarisation time was defined as the instant of steepest downstroke of the AP. T wave polarity was mostly determined by TR. Positive T waves occurred at early-repolarising sites. Correlation between Tup and TR was >0.99, in both negative and positive T waves. T wave area and peak value also correlated highly with TR. Conclusion: The polarity of the T wave is primarily determined by TR. Positive T waves occur at early-repolarising sites. Local TR is best estimated by Tup, also in positive T waves.

Keywords: Unipolar electrogram, ventricular repolarisation, computer model

Mark Potse, Ruben Coronel, Tobias Opthof, Alain Vinet. The positive T wave. Anatol J Cardiol. 2007; 7(Suppl 1): 164-167

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