ECG OF THE WEEKECG OF THE WEEKPROF .Dr .G.ELANGOVAN’S UNIT PROF .Dr .G.ELANGOVAN’S UNIT

D.SUBBURAJD.SUBBURAJ

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

FINDINGS IN THIS ECG

Rate -200/minRegular rhythmInverted P waves –II,III,AvfQRSD-126 msLeft axis deviationLBBB patternWide complex tachycardiaST, T depression I, aVL

INVERTED P WAVES

DD FOR WCT• Ventricular tachycardia• SVT with–Aberrant interventricular conduction–Pre excitation–Abnormal base line QRS–Ventricular pacing

RS INTERVAL

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

BRUGADA’S CRITERIA

Arrythmias in pre excitation

• Regular – mostly AVRT• Wide complex tachycardia

-orthodromic AVRT with aberrancy -antidromic AVRT -atrial arrythmia with antegrade conduction

• Irregular –atrial arrythmias

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

• Asssociated with BBB ( MC-LBBB)• RP>100ms• No pseudo R ,pseudo S .

THANK U