ECG of the Week - 12th February 2018 - Interpretation

The following ECG is from a 12 yr old male who presented to the Emergency Department following an episode of palpitations and near-syncope. he has no past medical history.

Click to enlarge

Rate:

• 66 bpm

Rhythm:

• Regular
• Sinus rhythm

Axis:

• Normal

Intervals:

• PR - Short(~100ms)
• QRS - Prolonged (120ms)
• QT - 360ms (QTc Bazette 380 ms)

Additional:

• T wave inversion leads aVR, aVL, V1
• Biphasic T wave in lead V2
• Delta wave best seen in leads I,V2-4
• Notching initial portion of QRS in leads II, III, aVF

Interpretation:

• Wolff-Parkinson-White (WPW) Syndrome
• Pre-excitation evidence by PR shortening, QRS prolongation and Delta Waves

What happened ?

Given the history of near syncope with palpitations the patient was admitted under paediatric cardiology for monitoring of likely tachyarrhythmia.

References / Further Reading

Life in the Fast Lane

• Pre-Excitation

Textbook

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