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Ventricular pre-excitation (Wolff-Parkinson-White pattern): Difference between revisions
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Ventricular pre-excitation (Wolff-Parkinson-White pattern) (view source)
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[[Image:wolffparkinsonwhite.jpg|thumb| Louis Wolff, Sir John Parkinson and Paul Dudley, who discovered the phenomenon that later would be called the WPW syndrome.]] | [[Image:wolffparkinsonwhite.jpg|thumb| Louis Wolff, Sir John Parkinson and Paul Dudley White, who discovered the phenomenon that later would be called the WPW syndrome.]] | ||
[[Image:Rhythm_WPW.png|thumb| The upstroke of the QRS-complex is 'slurred', resulting in a delta-wave (arrow).]] | [[Image:Rhythm_WPW.png|thumb| The upstroke of the QRS-complex is 'slurred', resulting in a delta-wave (arrow).]] | ||
[[Image: | [[Image:wpw2.svg|thumb|Conduction through the accessory pathway results in a delta wave.]] | ||
[[Image:OCT_ACT.svg|thumb| A atrioventricular tachycardia through the accessory bundle. The electrical signal travels from the ventricles via the accessory bundle to the atria and returns to the ventricles via the AV node.]] | |||
In 1930 Louis Wolff, Sir John Parkinson and Paul Dudley White described 11 patients who suffered from bouts of tachcyardias. Their ECGs showed two abnormalities: a short PQ time and a delta-wave. | In 1930 Louis Wolff, Sir John Parkinson and Paul Dudley White described 11 patients who suffered from bouts of tachcyardias. Their ECGs showed two abnormalities: a short PQ time and a delta-wave. | ||
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== Determining the location of the accessory pathway == | == Determining the location of the accessory pathway == | ||
By closely observing the shape of the delta wave on the ECG, the location of the accessory connection can often be estimated. Several algorithms have been developed for this purpose.<cite>Milstein</cite> | |||
| | [[Image:Pathway_nomenclature.png|thumb|left|300px|Seen from the apex, the tricuspid and mitral valve form a plane, relative to which the accessory connections are named.<cite>cosio</cite>]] | ||
| | [[Image:Pathway_prevalence.png|thumb|right|300px|Large differences in prevalence of accessory bundle location]] | ||
| | [[Image:Milstein_algorythm.png|thumb|300px|The Milstein algorhythm is relatively straightforward. Adapted from: <cite>Milstein</cite>]] | ||
|| | [[Image:Arruda_algorhythm.png|thumb|left|300px|The Arruda algorhythm. Adapted from: <cite>Arruda</cite>]] | ||
| | {{clr}} | ||
| | |||
| | == Examples == | ||
<gallery> | |||
Image:wpw_full_ecg.jpg|WPW on a 12 lead ECG | |||
Image:wpw_full_ecg2.jpg|Another example of pre-exitation on a 12 lead ECG | |||
Image:wpw_full_ecg3.png|Another example of WPW on a 12 lead ECG | |||
Image:ECG000029.jpg| Atrial fibrillation in a patient with WPW: Fast Broad Irregular (FBI) | |||
Image:ECG000030.jpg| Same patient as above during sinus rhythm: evident delta wave | |||
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</gallery> | |||
== References == | == References == | ||
<biblio> | <biblio> | ||
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#Pappone pmid=14602878 | #Pappone pmid=14602878 | ||
#Milstein pmid=2440006 | #Milstein pmid=2440006 | ||
#Arruda pmid=9475572 | |||
</biblio> | </biblio> | ||