1. ECG Rounds
July 22, 2004
Adam Oster R4

2. 14M with Palpitations:

3. 14M with Palpitations

4. 14M in sinus

5. 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%)

6. Orthodromic AVRT Usually initiated by PAC Accessory pathway refractory
PAC  Anterograde conduction down AVN and retrograde up accessory pathway
Narrow QRS

7. AVRT vs AVNRT: Rosen 2002

8. AVNRT vs AVRT: Journal of the American College of Cardiology. May, 2003.

9. AVNRT vs AVRT N=148 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

12. AVNRT vs AVRT

13. AVNRT

14. AVNRT

15. AVNRT vs AVRT
Accuracy = 91%

17. AVNRT

18. Usefulness of the ST-Segment in aVR
American Journal of Cardiology. December, 2003.
N=338 in PSVT
All had EP studies

19. The ST-segment in aVR

20. AVRT

21. AVRT

22. Usefulness of the ST-Segment in aVR
ST seg elevation in AVR
For AVRT
Sens 71%
Spec 70%
Accuracy 70%

23. AVRT

24. AVNRT vs AVRT: Putting it All Together
Psudo r’  think AVNRT
Inferior leads
Psuedo S  think AVNRT
ST up in AVR
Think AVRT (but not only)

27. Management Principles
Stability
Narrow vs wide
Regular vs irregular

28. AF/antidromic/WCT

30. WPW: Localising 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

31. Anteroseptal pthwy

32. Axis

34. Lt lateral pathway