Post-LBBB T Wave Inversion

Report:

Sinus rhythm

Intermittent LBBB

Widespread symmetrical T wave inversion

Prolonged QT interval 0.60”

Comment:

This patient, with recurrent TIAs, could have post-syncopal T wave inversion. There was, however, no history of any “event” - cerebral or cardiac, and no clinical evidence for one. Most likely, the inversion is the result of previous LBBB conduction. It is also seen, at times, following periods of paced rhythm (also with LBBB morphology), VT or aberrant SVT.

The mechanism of T wave inversion following LBBB conduction is unknown132. The inversion is transient and its only significance lies in its differential diagnosis.

Below is an ECG entirely in normal conduction, but with a memory of what preceded it (Fig 175a).

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