Vectorcardiographic Determinants of Cardiac Memory During Normal Ventricular Activation and Continuous Ventricular Pacing

Background: Cardiac memory (CM) refers to persistent T-wave changes on resumption of normal conduction after a period of abnormal ventricular activation. Traditionally, to observe CM, normal ventricular activation had to be restored, limiting the exploration of this phenomenon in clinical practice.

Objective: This study sought to prove that CM can be detected during continuous aberrant activation and to establish factors affecting its magnitude using a vectorcardiographic technique.

Methods: Sixteen nonpacemaker-dependent patients (11 male, age 72 +/- 8 years, mean +/- SD) undergoing pacemaker/internal cardioverter-defibrillator implantation were paced in DDD mode with a short atrioventricular (AV) delay for 7 days to induce CM. Electrocardiograms were acquired during AAI and DDD pacing at a constant rate before and after CM induction. Dower transform-derived vectorcardiograms were reconstructed and analyzed.

Results: T vector during AAI pacing changed in both magnitude (baseline, 0.26 +/- 0.10 mV; Day 7, 0.39 +/- 0.13 mV, P < .01) and direction aligning with the paced QRS vector (baseline DDD QRS - AAI T angle 125 degrees +/- 36 degrees; Day 7, 39 degrees +/- 21 degrees, P < .01). During DDD pacing, there was no change in T-vector direction, but T amplitude decreased (baseline, 1.06 +/- 0.32 mV; Day 7, 0.71 +/- 0.26 mV, P < .01). CM measured as T-vector peak displacement (TPD) was identical in AAI and DDD mode (TPD 0.46 +/- .0.17 mV and 0.46 +/- 0.17 mV, respectively). Individual CM magnitude correlated with QRS/T-vector amplitude ratio during DDD pacing at baseline (r = 0.90).

Conclusion: CM can be reliably shown during continuous ventricular pacing, expanding its application to situations in which abnormal ventricular activation persists. Its magnitude is determined by the QRS/T-amplitude ratio of the ventricular paced beat.