Sunday, 25 January 2015

ECG of the Week - 19th January 2015 - Interpretation

This ECG is from a 23 yr old female who presented to the Emergency Department following an episode of palpitations. She is fit & healthy and was asymptomatic when this ECG was performed.
Check out the comments from our original post here.

Click to enlarge

  • ~66 bpm
  • Regular
  • Sinus rhythm
  • Normal (~40 deg)
  • PR - Short (100ms)
  • QRS - Prolonged (140ms)
  • QT - 440ms

  • Discordant ST-segments changes
    • ST Elevation leads aVR, V1-3
    • ST Depression leads I, II, aVL, aVF, V5-6


  • Delta-waves lateral leads
  • Dominant S wave lead V1
    • Type B Pattern
  • Wolff-Parkinson-White Syndrome
    • Short PR segment
    • QRS Prolongation
    • Delta waves

Accessory Pathway Location

There are a number of algorithms that can be used to estimate the location of the accessory pathway (AP). Many of these algorithms can be found in smartphone apps, I use EP Mobile which contains the following algorithms:
  • Arruda Algorithm
  • Milstein Algorithm
  • Modified Arruda Algorithm
For this particular ECG are the algorithms give the same AP location which is antero-septal.
You can find an overview of each of these algorithms at ECGpedia's WPW page.

What are you going to tell your patient ?

I've put some links here to various patient information resources for WPW, I have not vetted or reviewed all these links but have chosen those from government / institutional sites.

If there are other links you feel should be added please comment and I'll add them.

References / Further Reading

Life in the Fast Lane

  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.