A Characteristic Precordial Repolarization Abnormality with Intermittent Left Bundle-Branch Block

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Abstract
ECG of 23 patients with intermittent left bundle-branch block were reviewed. A characteristic ECG pattern consisting of right and mid-precordial deep symmetrical T-wave inversions was detected during normal conduction in 19 of the 23. Of the 7 patients who had cardiac catheterization, only 2 had findings suggestive of organic heart disease and only 1 had significant obstructive coronary disease. Patients with intermittent left bundle-branch block frequently have T-wave inversions in right and mid-precordial leads during normal conduction that do not necessarily reflect coronary disease. These T-wave changes are similar to those after termination of chronic right ventricular pacing (left bundle-branch pattern), suggesting that both patterns of abnormal ventricular activation can produce abnormal repolarization when activation returns to normal.