T-Wave Inversion in Young Female

Corresponding author: Juan Salazar, Instituto de Investigaciones de Enfermedades Cardiovasculares de La Universidad del Zulia, Maracaibo, Venezuela. E-mail: juanjsv18@hotmail.com A 24-year-old female patient, without family or personal pathological history, came to the outpatient service because of frequent episodes of palpitations accompanied by generalized weakness and dizziness without loss of consciousness, a duration of several hours, and their selflimited nature. A 12-lead electrocardiogram was performed, which showed sinus rhythm, 88 beats per minute, a short PR interval, a widened QRS complex with initial slurring, and repolarization changes, findings that are consistent with that of Wolff–Parkinson–White (WPW) pattern, possibly right inferior paraseptal atrioventricular accessory pathway (Figure 1A). During the procedure, a right inferior paraseptal atrioventricular (previously called right posteroseptal) accessory pathway was found, with right atria stimulation radiofrequency energy applied with fixed cycles of 500 ms, acquiring atrioventricular (AV) separation and dissociation of ventriculoatrial retroconduction, and an electrocardiogram in sinus rhythm with 88 beats per minute, a PR interval of 160 ms, a QRS complex of 80 ms, a QRS axis of 60°, and symmetrical T-wave inversion (TWI) in DII, DIII, and aVF leads (Figure 1B). Radiofrequency ablation was performed without atrial pacing. The patient was discharged without instantaneous complications. During the follow-up evaluation, 10 days after the procedure, the patient was asymptomatic, with no new episodes of palpitations, and an electrocardiogram in sinus rhythm with 83 beats per minute, PR interval of 160 ms, QRS complex of 80 ms, QRS axis of 60°, and normal repolarization changes (Figure 2). The patient was managed conservatively due to a suspicion of cardiac memory phenomenon . The secondary changes in ST segment and T-wave are due to alterations in the ventricular activation sequence. When this is normalized, the repolarization changes are immediately