Persistent juvenile T-wave pattern

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Juvenile T waves

Overview

The Juvenile T-wave pattern refers to a normal electrocardiographic variant in which T wave inversions are present in precordial leads V₁, V₂, and V₃ along with an early repolarization pattern. Shallow T-wave inversion is usually found in the right precordial leads (V1-V3) during infancy. T wave then rises upwards during childhood. If this inverted T-wave pattern sustained to adulthood, it is called persistent juvenile T-wave pattern.

Natuarl History, Complications, Prognosis

Juvenile T-waves may persists into adulthood with no adverse sequela.

Differentiating persistent Juvenile T-wave pattern from other causes of T-wave inversion

Persistent juvenile T-wave inversion must be differentiated from other diseases that cause T-wave inversion, such as:   

• Arrhythmogenic RV dysplasia should be suspected in this cohort if the T wave inversion persists beyond lead V₁ in a post pubertal male athlete

• Cerebrovascular accidents can cause deep widely splayed T waves referred to as cerebral T waves

• Digoxin effect or Dig effect

• Electrolyte disturbance

• Ischemic heart disease including non ST segment elevation MI or prior MI

• Left bundle branch block, it is normal for the T wave to be inverted if the QRS complex is upright

• Left ventricular hypertrophy with strain

• Myocarditis

• Premature ventricular contraction

• Pulmonary embolism, particularly in the anterior precordium

• Restrictive cardiomyopathy

• Subarachnoid hemorrhage

• Unstable angina

• Wellens' syndrome

• Wolff-Parkinson-White syndrome (WPW)