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Electrical Diseases of the Heart pp 415–433Cite as

Cardiac Memory: From Electrical Curiosity to Clinical Diagnostic and Research Tool

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Abstract

The term “Cardiac memory” (CM) refers to persistent changes in myocardial repolarization upon resumption of normal ventricular conduction sequence after a period of abnormal ventricular activation (such as ventricular arrhythmias, pacing, or transient conduction abnormalities) manifesting by the typical pattern of the T wave changes on the ECG. In CM T wave direction follows the direction of the preceding aberrant QRS complex.

CM is believed to reflect adaptation of the heart to the new activation sequence and is triggered by changes in myocardial strain causing local release of angiotensin II. CM involves alterations in ion channel trafficking (short-term CM), transcription and expression of multiple ion channels including Ito, IKr, ICa-L, and gap junction redistribution (long-term CM).

In the clinical setting T wave inversions due to CM are often confused with myocardial ischemia.

Recent studies demonstrated that CM can be observed not only during normal ventricular activation but continuous aberrant conduction and its magnitude depends on the aberrant QRST morphology (particularly QRS/T vector magnitude ratio) and the degree of the left ventricular dyssynchrony.

Clinical applications of CM reviewed including differential diagnosis of T wave inversions, left bundle branch block age determination and potential use in pacemaker-related clinical research.

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Authors and Affiliations

  1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Bake4/Cardiology, 185 Pilgrim Road, Boston, MA, 02215, USA

    Alexei Shvilkin MD

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Correspondence to Alexei Shvilkin MD .

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  1. , Department of Internal Medicine, UMDNJ-RWJ Medical School, Robert Wood Johnson Pl. 1, New Brunswick, 08903-0019, New Jersey, USA

    Ihor Gussak

  2. , Gordon K. Moe Scholar, Masonic Medical Research Laboratory, Bleecker Street, Utica, 13501-1787, New York, USA

    Charles Antzelevitch

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Shvilkin, A. (2013). Cardiac Memory: From Electrical Curiosity to Clinical Diagnostic and Research Tool. In: Gussak, I., Antzelevitch, C. (eds) Electrical Diseases of the Heart. Springer, London. https://doi.org/10.1007/978-1-4471-4881-4_25

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