Author + information
Although early repolarization pattern (ERP) have been considered for long time to be a normal electrocardiographic finding, it was proved in recent studies to cause sudden cardiac death. Exact mechanism underling this electrocardiographic phenomenon is not well established. False tendons are (FT) fibromuscular bands that transverse the left ventricular cavity and often contain conduction tissue which proved in some case reports to cause ventricular tachycardia.
To investigate the electrocardiographic characteristics of patients with false tendons.
We studied 60 non cardiac patients with FTs and 60 non cardiac patients with ERP. Patients were classified according to presence of ERP and FTs to: ERP+FT (group 1, n=52) and ERP or FT (group 2, n=68). ERP was defined as J point elevation manifested either as QRS slurring (transition from the QRS segment to the ST segment) or notching (positive deflection on terminal S wave), upper concavity ST segment elevation for more than 0.1mV and prominent T waves in at least 2 contiguous leads. False tendons were defined (by 2D TTE) as bands stretching across the left ventricle (LV) from the ventricular septum to the papillary muscle or LV free wall but not connecting, like the chordae tendinae, to the mitral leaflet. PRd, QRSd, QT, QTc, JT and JTc were calculated, site morphology of ST elevation was identified and amplitude of ERP and number of leads with ST elevation were calculated. Site and number of FTs were identified and length & thickness & volume of FT were measured. FTs were classified according to their points of attachment as type 1 (longitudinal), type 2 (diagonal), type 3 (transverse) and type 4 (weblike).
ERP was present in 29 patients (48.3%) of patients with FTs and FTs were present in 23 patients (38.3%) of patients with false tendons. Horizontal ST segment elevation was found in (61.4%) patients of those with ER and FT which is much more common than patients with ER alone (27.8%) and this was statistically significant (P= 0.007). We found that 80% of patients with ER pattern in the inferior leads have oblique FTs (P = 0.043) and 72% of patients with ER pattern in the inferolateral leads have transverse FTs (P = 0.05).
Our results suggest that FTs may play a role in genesis and determination of site and morphology of ERP.