ECG Rounds

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ECG Rounds

• July 22, 2004
• Adam Oster R4

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14M with Palpitations
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14M with Palpitations
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14M in sinus
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Accessory Pathway Syndromes

• WPW one of many accessory pathway diseases
• Bundle of Kent
• Classically 3 features
• Accessory pathway has longer refractory period
  during long cycle lengths (sinus rhythm)
• Can conduct faster than the AVN
• MC Tachycardia is
• orthodromic AVRT (70-80)

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Orthodromic AVRT

• Usually initiated by PAC
• Accessory pathway refractory
• PAC ? Anterograde conduction down AVN and
  retrograde up accessory pathway
• Narrow QRS

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AVRT vs AVNRT Rosen 2002
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AVNRT vs AVRTJournal of the American College of
Cardiology. May, 2003.

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AVNRT vs AVRT

• N148 with ECGs both in narrow-complex SVT and in
  SR
• Gold standard was electrophysiologic studies
  followed by catheter ablation if necessary
• 3 blinded EPs reviewing for apriori ECG findings

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AVNRT vs AVRT
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AVNRT
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AVNRT
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AVNRT vs AVRT
Accuracy 91
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AVNRT
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Usefulness of the ST-Segment in aVR

• American Journal of Cardiology. December, 2003.
• N338 in PSVT
• All had EP studies

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The ST-segment in aVR
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AVRT
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AVRT
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Usefulness of the ST-Segment in aVR

• ST seg elevation in AVR
• For AVRT
• Sens 71
• Spec 70
• Accuracy 70

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AVRT
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AVNRT vs AVRTPutting it All Together

• V1
• Psudo r ? think AVNRT
• Inferior leads
• Psuedo S ? think AVNRT
• ST up in AVR
• Think AVRT (but not only)

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Management Principles

• Stability
• Narrow vs wide
• Regular vs irregular

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AF/antidromic/WCT
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WPWLocalising the Pathway

• LOCATION V1 V2 QRS axis left posteroseptal (type
  A) ve ve left right lateral (type B) -ve -ve
  left left lateral (type C) ve ve inferior (90
  degrees) right posteroseptal -ve -ve left
  anteroseptal -ve -ve normal

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Anteroseptal pthwy
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Axis
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Lt lateral pathway