ECG Rounds July 22, 2004 Adam Oster R4.

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Presentation transcript:

ECG Rounds July 22, 2004 Adam Oster R4

14M with Palpitations:

14M with Palpitations

14M in sinus

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%)

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

AVRT vs AVNRT: Rosen 2002

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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

AVNRT vs AVRT

AVNRT

AVNRT

AVNRT vs AVRT Accuracy = 91%

AVNRT

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

The ST-segment in aVR

AVRT

AVRT

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

AVRT

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)

Management Principles Stability Narrow vs wide Regular vs irregular

AF/antidromic/WCT

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

Anteroseptal pthwy

Axis

Lt lateral pathway