ECG Guru - Instructor Resources - Wolff-Parkinson-White pattern https://www.ecgguru.com/ecg/wolff-parkinson-white-pattern en Wolff-Parkinson-White Syndrome https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-0 <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/wolff-parkinson-white-syndrome-0"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/PreEx%20WPW.jpg" width="1800" height="1245" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal">Here is a good example of an ECG showing the signs of Wolff-Parkinson-White syndrome during normal sinus rhythm.&nbsp; WPW is one of the “pre-excitation” syndromes caused by an accessory pathway between the atria and ventricles. Accessory pathways can bypass the AV node.&nbsp; These conduction pathways can conduct anterograde (forward toward the ventricles), retrograde (away from the ventricles), most commonly, in both directions.&nbsp; When the accessory pathway conducts in an anterograde fashion, it causes pre-excitation of the ventricles. See <a title="WPW conduction C Watford" href="http://ecgguru.com/heart-illustrations/accessory-pathway-conduction-compared-normal-conduction"><span style="color: #0070c0;">Illustration</span></a>.</p><p class="MsoNormal">Wolff-Parkinson-White syndrome is caused by an accessory pathway called the Bundle of Kent, which can occur on either the left or the right side of the heart.&nbsp; The ECG sign of the pre-excitation of the ventricles in WPW is a <strong>DELTA WAVE</strong>. &nbsp;The delta wave is seen in normal sinus rates when the accessory pathway conducts anterograde, pre-exciting the ventricles. The delta wave arises at the end of the P wave, eliminating the PR segment in some leads.&nbsp; In this ECG, the delta waves can best be seen in Leads I, II, aVR, and aVL, as well as in V1, V2, and V3.&nbsp;</p><p class="MsoNormal">People with WPW are prone to bouts of supraventricular tachycardia, called AV reentrant tachycardia (AVRT).&nbsp; A circular pathway can form between the normal AV pathways and the accessory pathway, causing an impulse to depolarize the ventricles and return to the atria in a rapidly repeating cycle, causing a paroxysmal supraventricular tachycardia. The delta waves will disappear as they become part of the reentrant cycle.</p><p class="MsoNormal">Tachyarrhythmias can also form when impulses from atrial flutter or <a title="Pre-excited a fib Jason Roediger" href="http://ecgguru.com/blog/jasons-blog-ecg-challenge-week-dec-16th-23rd"><span style="color: #0070c0;">atrial</span> <span style="color: #0070c0;">fibrillation</span></a> rapidly enter the ventricles through the accessory pathway without the filtering effect of the AV node.&nbsp; The extremely rapid rates produced in these situations can quickly lead to deterioration and ventricular fibrillation.</p><p>&nbsp;</p><p class="MsoNormal">For more information on WPW ECG signs, we recommend <span style="color: #0070c0;"><a title="WPW Life in the Fast lane" href="http://lifeinthefastlane.com/ecg-library/pre-excitation-syndromes/">Life In The Fast Lane</a>.&nbsp;</span></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/346/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wolff-Parkinson-White Syndrome 1/5</option><option value="40">Give Wolff-Parkinson-White Syndrome 2/5</option><option value="60">Give Wolff-Parkinson-White Syndrome 3/5</option><option value="80" selected="selected">Give Wolff-Parkinson-White Syndrome 4/5</option><option value="100">Give Wolff-Parkinson-White Syndrome 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="average-rating">Average: <span >3.5</span></span> <span class="total-votes">(<span >2</span> votes)</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-PDDLDwpo2RdwBlYPKQ62qHtgmBpDPESGOgNrHo3AlKg" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><div class="field field-name-field-taxonomy field-type-taxonomy-term-reference field-label-above"><div class="field-label">Related Terms:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/ecg/wolff-parkinson-white" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white-pattern" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White pattern</a></div><div class="field-item even"><a href="/ecg/pre-excitation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pre-excitation</a></div><div class="field-item odd"><a href="/ecg/delta-waves" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Delta waves</a></div><div class="field-item even"><a href="/ecg/wolff-parkinson-white-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White syndrome</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fwolff-parkinson-white-syndrome-0&amp;title=Wolff-Parkinson-White%20Syndrome"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Wed, 21 Oct 2015 04:05:28 +0000 Dawn 671 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-0#comments Jason's Blog: ECG Challenge of the Week for August 12-19. "Before" and "After" case. https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-august-12-19-and-after-case <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/jasons-blog-ecg-challenge-week-august-12-19-and-after-case"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/ECG%20of%20the%20Week%201h.PNG" width="765" height="856" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="font-size: 11.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; color: #009900; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Patient’s clinical data:</span></span></strong><span style="font-size: 11.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"><span style="mso-spacerun: yes;">&nbsp; </span>54-year-old black man.<span style="mso-spacerun: yes;">&nbsp; </span>PMH significant for atherosclerotic disease, HTN, CVA, PVD, ETOH abuse, and substance abuse.<span style="mso-spacerun: yes;">&nbsp; </span>Previous cardiac cath showed angiographically insignificant CAD.<span style="mso-spacerun: yes;">&nbsp; </span><br> <br> Both of these ECGs were performed just a single day apart from one another.<span style="mso-spacerun: yes;">&nbsp; </span>During that intervening period of time, this patient underwent a cardiac electrophysiology (EP) study and radio frequency ablation (RFA).&nbsp; <em></em><span style="mso-spacerun: yes;">During the procedure, atrial fibrillation was easily induced.&nbsp; </span>The pattern seen in Fig. 2 may have manifest as a direct result of the procedure <em style="mso-bidi-font-style: normal;">or</em> it may have been masked all along by the pattern seen in Fig. 1.<span style="mso-spacerun: yes;">&nbsp; </span><br> <br> <strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;">*NOTE:</span></strong><span style="mso-spacerun: yes;">&nbsp; </span>Prior to the procedure, all <em style="mso-bidi-font-style: normal;">previous</em> ECGs were consistent with Fig. 1.<span style="mso-spacerun: yes;">&nbsp; </span>All <em style="mso-bidi-font-style: normal;">subsequent</em> ECGs were consistent with Fig. 2. <br> <br> As part of its interpretations, the computer made the following statements regarding each ECG.<br> <strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue; text-decoration: underline;">Fig. 1:</span></span></strong> Inferior myocardial infarction, Age indeterminate <br> <strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: blue; text-decoration: underline;">Fig. 2:</span></span></strong> Possible inferior myocardial infarction<br> <br> <strong style="mso-bidi-font-weight: normal;">DO YOU AGREE WITH THE COMPUTER?</strong><br> <br> <strong style="mso-bidi-font-weight: normal;"><span style="text-decoration: underline;"><span style="color: #cc0000; text-decoration: underline;">Questions:</span></span></strong><span style="mso-spacerun: yes;">&nbsp; </span><span style="mso-spacerun: yes;">&nbsp;</span><br> (1.)<span style="mso-spacerun: yes;">&nbsp; </span>Should we be concerned by the alteration of the QRS morphology?<span style="mso-spacerun: yes;"><br>(2.)&nbsp; Why would you not want the ECG in Fig. 1 to be combined with atrial fibrillation?&nbsp; </span><br> (3.)<span style="mso-spacerun: yes;">&nbsp; </span>Does this patient require implantation of a permanent pacemaker?<br>(4.)&nbsp; In what way does the word "right" factor into the interpretations of both ECGs?<br></span></p> </div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/346/feed" method="post" id="fivestar-custom-widget--2" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--4" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 12-19. &amp;quot;Before&amp;quot; and &amp;quot;After&amp;quot; case. 1/5</option><option value="40">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 12-19. &amp;quot;Before&amp;quot; and &amp;quot;After&amp;quot; case. 2/5</option><option value="60">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 12-19. &amp;quot;Before&amp;quot; and &amp;quot;After&amp;quot; case. 3/5</option><option value="80">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 12-19. &amp;quot;Before&amp;quot; and &amp;quot;After&amp;quot; case. 4/5</option><option value="100">Give Jason&amp;#039;s Blog: ECG Challenge of the Week for August 12-19. &amp;quot;Before&amp;quot; and &amp;quot;After&amp;quot; case. 5/5</option></select> <div class="description"><div class="fivestar-summary fivestar-summary-average-count"><span class="empty">No votes yet</span></div></div> </div> </div> </div><input class="fivestar-submit form-submit" type="submit" id="edit-fivestar-submit--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-t2FT3wfZbsLxpQq9Rb2LDQXgJng_3ST7FHB51c8vX3I" /> <input type="hidden" name="form_id" value="fivestar_custom_widget" /> </div></form></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_2"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fblog%2Fjasons-blog-ecg-challenge-week-august-12-19-and-after-case&amp;title=Jason%27s%20Blog%3A%20ECG%20Challenge%20of%20the%20Week%20for%20August%2012-19.%20%22Before%22%20and%20%22After%22%20case."><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Sat, 11 Aug 2012 14:21:31 +0000 jer5150 299 at https://www.ecgguru.com https://www.ecgguru.com/blog/jasons-blog-ecg-challenge-week-august-12-19-and-after-case#comments