1. ECG OF THE WEEKECG OF THE WEEK
PROF .Dr .G.ELANGOVAN’S UNITPROF .Dr .G.ELANGOVAN’S UNIT
D.SUBBURAJD.SUBBURAJ

2. • 54/M known WPW on
T . Verapamil,
discontinued for 2 days,
developed palpitations, ECG
taken

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

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

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

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