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Spontaneous T wave inversion after ventricular pacing: What is the probable mechanism?

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    Q1: Describe the ECG (fig 2)

    The ECG shows sinus rhythm with 2:1 atrioventricular block and a rate of 50 beats/min. Diffuse and deeply inverted T waves ( =  isolated giant negative T waves) that were not present in the ECG taken on admission are notable in all precordial leads. Note that the vector of inverted T waves is in accordance with the paced QRS complex that has left bundle branch block pattern, as shown in figure 1.

    Q2: What is the probable mechanism responsible for the newly developed abnormalities in the ECG (fig 2)?

    There are quite a number of reasons to be discussed in the differential diagnosis for spontaneous occurrence of T wave inversion (TWI). One of these reasons is coronary ischaemia and should be excluded in the differential diagnosis. Although spontaneous occurrence of a silent ischaemic episode could not be truly excluded in our patient, coronary ischaemia as a cause of TWI seems to …

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