The U Wave

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

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

U waves were described by Einthoven in 1903 and normally have same polarity as T waves[1]

Pathophysiology

There are three hypotheses regarding the origin of the U wave[2]:

  1. Late repolarization of Purkinje fibers,
  2. Late repolarization of some other portions of left ventricle,
  3. Alteration in the normal action potential shape by after potentials.

Appearance

  1. Ordinarily the U wave has the same polarity as the T wave and is 5 to 25% of the T wave amplitude.
  2. Tallest in leads V2 and V3, usually not greater than 1.0 mm.
  3. Considered abnormally large if the U wave is greater than 1.5 mm in any lead.[3]

Causes of Abnormal U wave Prominence

U wave

  • Electrolyte imbalance

Causes of U Wave Inversion

  1. Left ventricular hypertrophy (in I, V5, V6)
  2. Right ventricular hypertrophy (in II, III)
  3. Ischemic heart disease

References

  1. Einthoven W. Die galvanometrische registrierung des menschlichen Electrokardiogram. Pfluger’s Arch 1903;99:472-480.
  2. Bernardo DD, Murray A. Origin on the electrocardiogram of U-waves and abnormal U-wave inversion. Cardiovasc Res 2002;53:202-208
  3. Chou's Electrocardiography in Clinical Practice. Third Edition, pp. 519-522.

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