ECG Guru - Instructor Resources - Wolff-Parkinson-White https://www.ecgguru.com/ecg/wolff-parkinson-white en Normal Conduction Compared To Conduction Over An Accessory Pathway https://www.ecgguru.com/heart-illustrations/normal-conduction-compared-conduction-over-accessory-pathway <div class="field field-name-field-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="https://www.ecgguru.com/sites/default/files/ecg-heart-art/Normal%20Conduction%20Compared%20to%20Conduction%20Over%20An%20Accessory%20Pathway.jpg"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/styles/medium/public/ecg-heart-art/Normal%20Conduction%20Compared%20to%20Conduction%20Over%20An%20Accessory%20Pathway.jpg?itok=-D48eYq_" width="220" height="123" alt="Normal Conduction Compared To Conduction Over An Accessory Pathway" title="Normal Conduction Compared to Conduction Over An Accessory Pathway" /></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 style="background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial;"><span style="font-size: 8pt; font-family: Arial, sans-serif;">This is an original illustration by Dawn Altman. You may use it free of charge to enhance your presentations or student handouts. Click on image, or right click and SAVE image. For permission and charges for use in publications or for marketing uses, please contact the artist at </span><a href="mailto:Dawn.ECGGuru@gmail.com"><span style="font-size: 8.0pt; font-family: 'Arial',sans-serif;">Dawn.ECGGuru@gmail.com</span></a><span style="font-size: 8pt; font-family: Arial, sans-serif;">&nbsp; </span></p><p>&nbsp;</p><p class="MsoNormal"><span style="font-size: 10.0pt; font-family: 'Helvetica',sans-serif; mso-bidi-font-family: Helvetica; color: gray; mso-ansi-language: EN;" lang="EN">&nbsp; </span><span style="font-size: 8.0pt; font-family: 'Helvetica',sans-serif; mso-bidi-font-family: Helvetica; color: gray; mso-ansi-language: EN;" lang="EN">This work is licensed under a </span><a href="http://creativecommons.org/licenses/by-nc/3.0/"><span style="font-size: 8.0pt; font-family: 'Helvetica',sans-serif; mso-bidi-font-family: Helvetica; mso-ansi-language: EN;" lang="EN">Creative Commons Attribution-NonCommercial 3.0 Unported License</span></a><span style="font-size: 8.0pt; font-family: 'Helvetica',sans-serif; mso-bidi-font-family: Helvetica; color: gray; mso-ansi-language: EN;" lang="EN">.</span></p></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/illustration-accessory-pathway" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Illustration: Accessory pathway</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%2Fheart-illustrations%2Fnormal-conduction-compared-conduction-over-accessory-pathway&amp;title=Normal%20Conduction%20Compared%20To%20Conduction%20Over%20An%20Accessory%20Pathway"><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> Fri, 24 Nov 2017 01:24:31 +0000 Dawn 744 at https://www.ecgguru.com https://www.ecgguru.com/heart-illustrations/normal-conduction-compared-conduction-over-accessory-pathway#comments Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome https://www.ecgguru.com/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome <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/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/13M%20SVT%20WPW%20ECG2%20don%27t%20know%20time.jpg" width="1800" height="1141" alt="" /></a></div><div class="field-item odd"><a href="/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/image_2.jpg" width="1800" height="1141" 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" style="margin-bottom: .0001pt; line-height: normal;">This ECG was obtained from a 13-year-old boy who had previously been in NSR. &nbsp;At that time, he was diagnosed with <a href="http://ecgguru.com/ecg/wolff-parkinson-white-syndrome-0">Wolff-Parkinson-White syndrome</a>, and he had delta waves.&nbsp; He now presents with a supraventricular tachycardia.&nbsp; People with W-P-W have one or more accessory pathways which allow atrial impulses to bypass the AV node and “pre-excite” the ventricles.&nbsp; An accessory pathway, along with the normal pathway through the AV node, can form a functional circuit, allowing conduction to proceed down one pathway and return up the other, in a rapidly repeating circular motion.&nbsp; This causes paroxysmal supraventricular tachycardia.<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">In W-P-W, the most common type of SVT is AV reciprocating tachycardia (AVRT), also called AV reentry tachycardia.&nbsp; Conduction through the accessory pathway can be forward (anterograde) or backward (retrograde).&nbsp; The most common type of reentrant conduction in W-P-W is <strong>ORTHODROMIC</strong>, which we see here.&nbsp; The impulse conducts forward through the AV node, and backward over the accessory pathway.&nbsp; There is no delta wave, as there is no pre-excitation of the ventricles.<span style="font-size: 8pt;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong>Features of orthodromic AVRT are: </strong></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Fast rate (usually approximately 140-250 beats per minute) &nbsp; &nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Narrow QRS complexes (unless BBB or IVCD present) &nbsp;&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">P waves retrograde, if seen (negative in II, positive in aVR and V1) &nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">ST depression and T wave inversion common.</span><span style="font-size: 13.008px; line-height: 1.538em;">&nbsp;</span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px; line-height: 1.538em;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">W-P-W is often diagnosed in children and teenagers.&nbsp; Treatment depends upon the hemodynamic stability of the patient during episodes of SVT.&nbsp; Catheter ablation can be used to disable the accessory pathway in many cases.</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">&nbsp;</p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">*. The second image has been added to accompany Dr. Ken Grauer's comments below.&nbsp;</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/549/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 Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 1/5</option><option value="40">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 2/5</option><option value="60">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 3/5</option><option value="80" selected="selected">Give Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome 4/5</option><option value="100">Give Supraventricular Tachycardia in Pediatric Patient With 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 >3.8</span></span> <span class="total-votes">(<span >5</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-aFL0kIsPZpcQd9d48dwCEGZ0TA7Evrfg4i56WEcLsrs" /> <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/pediatric-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pediatric ECG</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white-syndrome" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White syndrome</a></div><div class="field-item even"><a href="/ecg/w-p-w" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">W-P-W</a></div><div class="field-item odd"><a href="/ecg/wolff-parkinson-white" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Wolff-Parkinson-White</a></div><div class="field-item even"><a href="/ecg/supraventricular-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Supraventricular tachycardia</a></div><div class="field-item odd"><a href="/ecg/svt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">SVT</a></div><div class="field-item even"><a href="/ecg/avrt" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AVRT</a></div><div class="field-item odd"><a href="/ecg/av-reentry-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">AV Reentry Tachycardia</a></div><div class="field-item even"><a href="/ecg/reciprocating-tachycardia" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Reciprocating tachycardia</a></div><div class="field-item odd"><a href="/ecg/pre-excitation" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pre-excitation</a></div><div class="field-item even"><a href="/ecg/accessory-pathway" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Accessory pathway</a></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%2Fecg%2Fsupraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome&amp;title=Supraventricular%20Tachycardia%20in%20Pediatric%20Patient%20With%20Wolff-Parkinson-White%20Syndrome"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Tue, 01 Dec 2015 17:34:39 +0000 Dawn 679 at https://www.ecgguru.com https://www.ecgguru.com/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome#comments 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/549/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 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--2" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-BOG-Bbf8BhHOmg3dMNw2oXDUH3h56JEGaDRmGhk3wpM" /> <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_3"> <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> </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 Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-four-year-old-girl <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-four-year-old-girl"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WPW100.jpg" width="1400" height="767" 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>WPW is one of the "pre-excitation" syndromes caused by an accessory pathway that bypasses the AV node. This pathway is called the Bundle of Kent. This ECG clearly demonstrates the "delta wave" caused by the atrial impulse traveling around the AV node and pre-exciting part of the ventricle. These delta waves are best seen in Leads I and V4 - V6. The delta wave in Lead II is a small notch. A short PR interval is also seen. The accessory pathway can, along with the normal pathway through the AV node, form a circle or circuit, making the heart vulnerable to re-entrant tachycardia. This ECG is from a four-year-old girl who had not been previously diagnosed.</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/549/feed" method="post" id="fivestar-custom-widget--3" 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--6" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl 1/5</option><option value="40">Give Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl 2/5</option><option value="60">Give Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl 3/5</option><option value="80">Give Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl 4/5</option><option value="100">Give Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl 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--3" name="op" value="Rate" /><input type="hidden" name="form_build_id" value="form-E5293vLLaXGEAhhAWTSCGuLOmLKb6NX4zvkcZgrAXS8" /> <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/pediatric-ecg" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Pediatric ECG</a></div><div class="field-item even"><a href="/ecg/accessory-pathway" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Accessory pathway</a></div><div class="field-item odd"><a href="/ecg/kent-bundle" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Kent Bundle</a></div><div class="field-item even"><a href="/ecg/delta-wave" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">Delta wave</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_4"> <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-four-year-old-girl&amp;title=Wolff-Parkinson-White%20Syndrome%20in%20a%20Four-Year-Old%20Girl"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> </span></li> </ul> Mon, 19 Dec 2011 18:21:07 +0000 Dawn 140 at https://www.ecgguru.com https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-four-year-old-girl#comments