Electrocardiogram phenotypes in hypertrophic cardiomyopathy caused by distinct mechanisms: apico-basal repolarization gradients vs. Purkinje-myocardial coupling abnormalities

Abstract

Two ECG-based HCM phenotypes are explained by distinct mechanisms: ionic remodelling and action potential prolongation in hypertrophied apical and septal areas lead to T wave inversion with normal QRS complexes, whereas abnormal Purkinje-myocardial coupling causes abnormal QRS morphology in V4-V6. These findings have potential implications for patients' management as they point towards different arrhythmia mechanisms in different phenotypes.