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- Sinus arrhythmia
- PR - Short (~100ms)
- QRS - Prolonged (120-130ms)
- QT - 440ms (QTc Bazette 440 ms)
- ST elevation leads III, aVF <1mm with flat morphology
- Delta waves leads I, V1-4
- Pseudo right ventricular hypertrophy secondary to pre-excitation rather than actual chamber enlargement with the following ECG features:
- Dominant R wave leads V1-6
- R/S ratio >1 in lead V1
- T wave inversion leads aVL, V1-3
- Wolff-Parkinson-White Syndrome
- Left posterior / left posterolateral accessory pathway using Arruda algorithm
What happened ?
The patient had known pre-excitation and had been non-compliant with beta-blocker and sodium-channel blocker therapy. The patient was admitted for telemetry and re-instigation of anti-arrhythmic agents prior to ablation consideration / planning.
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.