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  • 1. ECG OF THE WEEK PROF .Dr .G.ELANGOVAN’S UNIT D.SUBBURAJ
  • 2.
    • 54/M known WPW on T . Verapamil, discontinued for 2 days, developed palpitations, ECG taken
  • 3.  
  • 4. FINDINGS IN THIS ECG
    • Rate -200/min
    • Regular rhythm
    • Inverted P waves –II,III,Avf
    • QRSD- 126 ms
    • Left axis deviation
    • LBBB pattern
    • Wide complex tachycardia
    • ST, T depression I, aVL
  • 5. INVERTED P WAVES
  • 6. DD FOR WCT
    • Ventricular tachycardia
    • SVT with
      • Aberrant interventricular conduction
      • Pre excitation
      • Abnormal base line QRS
      • Ventricular pacing
  • 7.  
  • 8. RS INTERVAL
  • 9. VT / SVT WITH ABERRANCY
    • QRSD>160ms
    • AV dissociation
    • Regular R-R
    • Extreme axis
    • R on T phenomenon
    • Fusion, capture beats
    • Concordance in precordial leads
    • 120-160ms
    • Conducted P waves
    • Regular /irregular
    • Normal except in WPW
    • Absent
    • Absent
    • Abent
  • 10. BRUGADA’S CRITERIA
  • 11.  
  • 12.  
  • 13.  
  • 14. Arrythmias in pre excitation
    • Regular – mostly AVRT
    • Wide complex tachycardia -orthodromic AVRT with aberrancy -antidromic AVRT -atrial arrythmia with antegrade conduction
    • Irregular –atrial arrythmias
  • 15.  
  • 16. AVRT
    • MC- orthodromic (90%)
    • Antidromic (5%)
    • Due to anomalous pathway
    • PAC -blocked in aberrant pathway-conducted in AV node-activates ventricle-reenter in to atria through aberrant pathway –retrograde P waves
  • 17.
    • Asssociated with BBB ( MC-LBBB)
    • RP>100ms
    • No pseudo R ,pseudo S .
  • 18. THANK U