The U wave and aberrant intraventricular conduction

Further evidence for the purkinje repolarization theory on genesis of the U wave
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      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.
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