Advertisement

The U wave and aberrant intraventricular conduction

Further evidence for the purkinje repolarization theory on genesis of the U wave
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The Purkinje system repolarization theory on the genesis of the U wave was tested by correlating the incidence of aberrancy of atrial premature systoles with the timing of the U wave and other measurements in 126 electrocardiograms selected from 6,000 records. Coupling (Rs-Rp) intervals were measured from the onset of the QRS complex of a sinus (s) beat to that of the premature (p) beat, and 149 different Rs-Rp intervals were studied. Criteria used for diagnosing aberrancy were significant changes in the QRS amplitude and significant alterations in the QRS contour. The incidence of aberrancy was plotted against (1) the Rs-Rp interval; (2) the ratio between the Rs-Rp and Rs-Rs intervals (the basic cycle length); (3) the ratio between Ps-Pp (the interval from a sinus P wave to a premature P wave) and Ps-Ps (the sinus cycle length); (4) the interval from the end of the preceding T wave to the premature QRS complex (T-Rp interval); (5) the interval from the apex of the U wave of the sinus beat to the premature QRS complex (aU-Rp); and (6) the interval from the end of the preceding U wave to the premature QRS complex (eU-Rp). As expected, a decrease in either of these values tended to increase the incidence of aberrancy. However, smooth S-shaped curves were noted with aU-Rp and eU-Rp intervals only. The correlation was much poorer with the other four measurements. Aberrancy with a typical right or left bundle branch block pattern was observed only when the premature QRS complex occurred before the apex of the U wave, the left bundle branch block pattern occurring with greater prematurity. It is concluded that the U wave most likely represents phase 3 repolarization of the Purkinje system, and propagation of supraventricular impulses during this period is the cause of aberrant ventricular conduction.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Watanabe Y
        Cardiac Arrhythmias. Electrophysiologic and Clinical Aspects.
        in: Bunkodo, Tokyo1973: 47 (in Japanese)
        • Bellet S
        Clinical Disorders of the Heart Beat.
        in: 2nd edition. Lea & Febiger, Philadelphia1963: 407
        • Bellet S
        Clinical Disorders of the Heart Beat.
        in: 2nd edition. Lea & Febiger, Philadelphia1963: 1061
        • Gouaux JL
        • Ashman R
        Auricular fibrillation with aberration simulating ventricular tachycardia.
        Am Heart J. 1947; 34: 366-373
        • Pick A
        Aberrant ventricular conduction of escape beats. Preferential and accessory pathways in the AV junction.
        Circulation. 1956; 13: 702-711
        • Kistin AD
        Atrioventricular junctional premature and escape beats with altered QRS and fusion.
        Circulation. 1966; 34: 740-751
        • Massumi RA
        Aberration of intraventricular conduction.
        in: Han J Cardiac Arrhythmias, A Symposium. Charles C Thomas, Springfield, Ill1972: 138-170
        • Moe GK
        • Mendez C
        • Han J
        Aberrant AV impulse propagation in the dog heart. A study of functional bundle branch block.
        Circ Res. 1965; 16: 261-286
        • Singer DH
        • Ten Eick RE
        Aberrancy: electrophysiologic aspects.
        Am J Cardiol. 1971; 28: 381-401
        • Toyama J
        Responses of the His-Purkinje conducting system to supraventricular premature beats. In vitro and in vivo canine experiments on ventricular aberrant conduction.
        Jpn Circ J. 1971; 40: 1701-1708
        • Lepeschkin E
        Physiologic basis of the U wave.
        in: Advances in Electrocardiography. Vol 2. Grune & Stratton, New York1975: 353-375
        • Watanabe Y
        Reassessment of parasystole.
        Am Heart J. 1971; 81: 451-466
        • Watanabe Y
        • de Azevedo IM
        Electrocardiographic correlation of bundle branch block and the U wave.
        J Electrocardiol. 1973; 6: 215-220
        • Watanabe Y
        Purkinje repolarization as a possible cause of the U wave in the electrocardiogram.
        Circulation. 1975; 51: 1030-1037
        • Massumi RA
        • Ertem GE
        • Vera Z
        Aberrancy of junctional escape beats. Evidence for origin in the fascicles of the left bundle branch.
        Am J Cardiol. 1972; 29: 351-359
        • Langendorf R
        Aberrant ventricular conduction.
        Am Heart J. 1951; 41: 700-707
        • Katz LN
        • Pick A
        Clinical Electrocardiography. Part I, The Arrhythmias.
        in: Lea & Febiger, Philadelphia1956: 250
        • Cohen SI
        • Lau SH
        • Scherlag BJ
        • et al.
        Alternate patterns of premature ventricular excitation during induced atrial bigeminy.
        Circulation. 1969; 39: 819-829
        • Watanabe Y
        • Dreifus LS
        Factors controlling impulse transmission with special reference to AV conduction.
        Am Heart J. 1975; 89: 790-803
        • Singer DH
        • Lazzara R
        • Hoffman BF
        Inter relationship between automaticity and conduction in Purkinje fibers.
        Circ Res. 1967; 21: 537-558
        • Elizari MV
        • Lazzari JO
        • Rosenbaum MB
        Phase-3 and phase-4 intermittent left anterior hemiblock. Report of 1st case in the literature.
        Chest. 1972; 63: 673-677
        • Anderson GJ
        • Greenspan K
        • Bandura JP
        • et al.
        Asynchrony of conduction within the canine specialized Purkinje fiber system.
        Circ Res. 1970; 27: 691-703
        • Hoffman BF
        • Moore EN
        • Stuckey JH
        • et al.
        Functional properties of the atrioventricular conducting system.
        Circ Res. 1963; 13: 308-328
        • Wit AL
        • Damato AN
        • Weiss MB
        • et al.
        Phenomenon of the gap in atrioventricular conduction in the human heart.
        Circ Res. 1970; 27: 679-689
        • Cohen SI
        • Lau SH
        • Haft JI
        • et al.
        Experimental production of aberrant ventricular conduction in man.
        Circulation. 1967; 36: 673-685
        • Ito M
        • Tanno M
        • Funato Y
        • et al.
        Aberrant ventricular conduction in atrial premature beats and atrial pacing. Studies with His bundle electrogram.
        Respir Circ (Tokyo). 1974; 22 (in Japanese): 333-338
        • Hoffman BF
        • Cranefield PF
        Electrophysiology of the Heart.
        in: McGraw-Hill, New York1960: 180-182
        • Hoffman BF
        • Cranefield PF
        Electrophysiology of the Heart.
        in: McGraw-Hill, New York1960: 274-275
        • Hoffman BF
        • Cranefield PF
        Electrophysiology of the Heart.
        in: McGraw-Hill, New York1960: 176
        • Sandler AI
        • Marriott HJL
        The differential morphology of anomalous ventricular complexes of right bundle branch block type in lead. VI. Ventricular ectopy versus aberration.
        Circulation. 1965; 31: 551-556
        • Myerburg RJ
        • Stewart JW
        • Hoffman BF
        Electrophysiological properties of canine peripheral AV conducting system.
        Circ Res. 1970; 26: 361-378
        • Moore EN
        • Hoffman BF
        • Patterson DF
        • et al.
        Electrocardiographic changes due to delayed activation of the wall of the right ventricle.
        Am Heart J. 1964; 68: 347-361
        • Lepeschkin E
        • Katz LN
        • Schaeffer H
        • et al.
        The U wave and afterpotentials in cardiac muscle: panel discussion.
        Ann NY Acad Sci. 1957; 65: 942-959
        • Scherf D
        The U wave in cardiac arrhythmias.
        Geriatrics. 1971; 26: 140-149