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ECG: UNDERSTANDING ACCELERATED CONDUCTION Dr. Krishnendu Maity BHMS [Calcutta] MD (Hom. Repertory) [Pune] Professor & HOD, Dept. of Medicine Teaching.

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Presentation on theme: "ECG: UNDERSTANDING ACCELERATED CONDUCTION Dr. Krishnendu Maity BHMS [Calcutta] MD (Hom. Repertory) [Pune] Professor & HOD, Dept. of Medicine Teaching."— Presentation transcript:

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2 ECG: UNDERSTANDING ACCELERATED CONDUCTION Dr. Krishnendu Maity BHMS [Calcutta] MD (Hom. Repertory) [Pune] Professor & HOD, Dept. of Medicine Teaching Medicine, Materia & Repertory Lal Bahadur Shastri Homœopathic Medical College, Bhopal – 26 (MP)

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4 INTRODUCTION There are 02 types of accelerated conductions from the atrium to the ventricles; viz. Wolff-Parkinson-White (WPW) Syndrome / Pre-excitation Syndrome. Lown-Ganong-Levine (LGL) Syndrome.

5 WPW SYNDROME Bundle of Kent by-pass the AV node or by Mahaim fibes – which goes from Bundle of His to Ventricular Septum. The pre-excitation of ‘Bundle of Kent’ is called WPW Syndrome. The atrial impulse passes through the normal path of conduction and also through the anterior intra-nodal fibre [Bachmann’s fibre / Bundle of Kent], simultaneously.

6 CLASSIFICATION OF WPW SYNDROME WPW Syndrome is of 02 types ---- WPW Syndrome is of 02 types ---- Type A: where excitation travels along Left accessory pathway – giving rise to RVH / RBBB. Type B: where excitation travels along Right lateral accessory pathways – giving rise to LBBB. If it is associated with Cyanotic CHD – Ebstein’s Anomaly is diagnosed.

7 ECG OF WPW Syndrome Short P-R interval [less than 0.12 sec.]. Wide QRS complex. Appearance of  -wave / slurred upstroke of QRS. Normal P-wave axis.

8 CAUSES OF WPW Syndrome Normal individuals. Myocardial Infarction. Acute Rheumatic Fever. CHD – Ebstein’s Anomaly. Cardiac catheterization / Surgical manipulation of Heart. Hypertrophic Sub-aortic Stenosis. Idiopathic Cardiomyopathy. Thyrotoxicosis.

9 WPW SYNDROME WITH ATRIAL FIBRILLATION Irregularly irregular, wide complex tachycardia. Impulses from the atria are conducted to the ventricles via either both the AV node and Accessory pathway producing a broad fusion complex. or just AV node producing a narrow complex (without  -wave). or just Accessory pathway producing a very broad 'pure'  - wave. People who develop this rhythm and have very short R-R intervals are at higher risk of VF.

10 LGL Syndrome James Accesory Tract / Bundle of James by-pass the upper part of the AV node. The pre-excitation of the ‘Bundle of James’ is called LGL Syndrome. The artrial impulse preferentially passes through the posterior intra-nodal fibre [Thorel’s fibre / Bundle of James] and conducted to His Bundle. Pateints of this syndrome are prone to develop Supra-ventricular arrhythmias, ventricular tachycardia & Ventricular fibrillation.

11 ECG OF LGL Syndrome Short P-R interval. Normal QRS complex. Normal T-wave. No  -wave.

12 LGL SYNDROME WITH ATRIAL FIBRILLATION Short PR interval [less than 3 small squares]. No  -wave.

13 REFERENCES 1.Das, Dr. P. C. – Textbook of Medicine [Reprint April, 1995; Current Book International]. 2.Ganong, Dr. William F. – Review of Medical Physiology (22 ND edition, 2005; McGraw Hill). 3.Mehta, Dr. P. J. – Understanding ECG [Reprint 6 TH edition, 2008; The National Book Depot].

14 THANKS TO ALL


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