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. 2010 Sep 7:4:77-83.
doi: 10.4137/cmc.s5892.

The Double U Wave-Should the Electrocardiogram be Interpreted Echocardiographically?

James Ker  1
Affiliations

The Double U Wave-Should the Electrocardiogram be Interpreted Echocardiographically?

James Ker. Clin Med Insights Cardiol. .

Abstract

The U wave is still an electrocardiographic deflection of enigmatic origin. Numerous hypotheses on its origin have been formulated, but to date none has been conclusively proven. Recently, a report described the first case of bifid (or notched) U waves. Until then this phenomenon has only been described in the T wave. This is the first report of double U waves-two separate deflections, ascribed to an accessory papillary muscle.

Hypothesis: The presence of a double U wave will be associated with an accessory papillary muscle (s).

Materials and methods: This is a retrospective analysis of 4729 patient files of patients who were evaluated at a cardiology practice. The 12-lead surface electrocardiogram was evaluated for the possible presence of a double U wave. In cases where a double U wave was found, the transthoracic echocardiogram was then scrutinized for the presence of an accessory papillary muscle.

Results: A total of 3 cases of a double U wave were found. In every case an accessory papillary muscle was clearly seen on the transthoracic echocardiogram.

Conclusion: A double U wave is a new variant of an old electrocardiographic deflection of enigmatic origin. This variant may be associated with an accessory papillary muscle.

Keywords: U wave; double; papillary muscle.

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Figures

Figure 1
Figure 1
Electrocardiogram of case 1. Note the striking double U waves in leads II, III, aVF and V3–V6.
Figure 2
Figure 2
Echocardiogram. Echocardiographic image demonstrating the accessory papillary muscle of case 1.
Figure 3
Figure 3
Echocardiogram. Additional echocardiographic image demonstrating the accessory papillary muscle of case 1.
Figure 4
Figure 4
Electrocardiogram of case 2. Electrocardiogram demonstrating double U waves in leads II, III, aVF and V3–V6.
Figure 5
Figure 5
Echocardiogram. Parasternal, short-axis view of case 2. Note the accessory papillary muscle, marked with +.
Figure 6
Figure 6
Electrocardiogram of case 3. Electrocardiogram demonstrating double U waves in leads II, III, aVF and V3–V6.
Figure 7
Figure 7
Echocardiogram. Parasternal, long-axis view of case 3, demonstrating the accessory papillary muscle just below the interventricular septum.
See this image and copyright information in PMC

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