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ECG - Wolff Parkinson White syndrome (WPW)

ECG Findings

Rate: most often 60-100 beats/min as usual rhythm is sinus
Rhythm: normal sinus except during pre-excitation tachycardia
PR: shorter since conduction through accessory pathway is faster than through AV node
P waves: normal conformation
QRS complex: classically distorted by delta wave (upwards deflection of QRS is slurred)

Wolff-Parkinson-White syndrome

Electrocardiograms from patients presenting with WPW demonstrate a group of characteristic findings frequently associated with paroxysmal tachycardias and atrial fibrillation.
In WPW, accessory pathways of accelerated ventricular impulse formation lead to the development of delta waves.
These waves resemble pathological Q waves and represent initial slurring of the QRS complex as a result of early ventricular depolarization through this accessory pathway (see lead II, V1 and V6 - arrow below).
As a result, the PR interval is shortened to less than 0.12 seconds and the QRS direction is altered (lead III), while its duration is extended to greater than Wolff-Parkinson-White syndrome 0.10 seconds.
Secondary T wave anomalies resulting from abnormal ventricular repolarization are often demonstrated (leads II, III, V2, V3 and V4).

Typical WPW ECG: short PR and delta wave

AVRT Orthodromic

This needs urgent treatment usually with vagal manoeuvres and adenosine, Rarely may need DC shock

AF with conduction down aberrant pathway: Danger ! Risk of VF

WPW

This needs urgent treatment which may include DC shock

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