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Spontaneous T wave inversion after ventricular pacing: What is the probable mechanism?

Q1: Describe the ECG (fig 2)
The ECG shows sinus rhythm with 2:1 atrioventricular block and a rate of 50 beats/min. Diffuse and deeply inverted T waves ( = isolated giant negative T waves) that were not present in the ECG taken on admission are notable in all precordial leads. Note that the vector of inverted T waves is in accordance with the paced QRS complex that has left bundle branch block pattern, as shown in figure 1.

Q2: What is the probable mechanism responsible for the newly developed abnormalities in the ECG (fig 2)?
There are quite a number of reasons to be discussed in the differential diagnosis for spontaneous occurrence of T wave inversion (TWI). One of these reasons is coronary ischaemia and should be excluded in the differential diagnosis. Although spontaneous occurrence of a silent ischaemic episode could not be truly excluded in our patient, coronary ischaemia as a cause of TWI seems to be unlikely, because of no symptoms and normal cardiac troponin 1 concentrations. In ventricular overload, however, . . . [Full text of this article]

Relevant Article

Spontaneous T wave inversion after ventricular pacing: What is the probable mechanism?

O Erdogan
Postgrad. Med. J. 2006 82: e20. [Extract] [Full Text] [PDF]