The dominant T wave and its significance

The Dominant T Wave. Introduction: The shapes of the T waves as observed in different leads placed on the thorax are very similar. The dominant T wave is introduced as a means to characterize this general signal shape. Its relationship to the transmembrane potentials of cardiac myocytes is discussed. Methods and Results: The source description of a biophysical model that previously was shown to yield realistic T waveforms was analyzed in order to exploit its relation to the transmembrane potentials of the cardiac myocytes at the surface bounding the myocardium. The product of this analysis is the dominant T wave: a waveform that describes the slope of the transmembrane potential. It is shown that the dominant T wave can be estimated easily from the matrix of sampled lead potentials. The timing of its peak reveals the mean of the repolarization times of the involved transmembrane potentials. The amplitude of the peak is the maximum downward slope of the transmembrane potential. This amplitude is independent of the volume conductor effects of the tissues surrounding the heart. The estimate of the dominant T wave retains this property. Conclusion: The dominant T wave reflects the derivative of the recovery phase of a generalized transmembrane potential. Its amplitude is independent of the volume conductor properties of the tissues surrounding the heart. This is a unique feature that greatly facilitates the interpretation and application of the other signal features of the dominant T wave.