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In patients with manifest anterograde ventricular preexcitation, the electrocardiographic manifestation of the anomalous conduction through the simultaneous conduction over the atrioventricular (AV) node and the accessory pathway ("delta wave"); depends on several factors, the most representative being the conduction velocity over one or another connection. Occasionally, ventricular ectopic beats may present with retrograde penetration over one or both conduction pathways (AV node and/or accessory pathway), impacting on the morphology of the next immediate anterogradely conducted QRS. We present a case of a young patient with WPW syndrome and ectopic ventricular beats with different manifestations on the postectopic QRS due to concealed penetration of different conduction pathways.

Electrocardiographic artifacts are extracardiac signals that may alter the electrocardiogram (ECG) generating false diagnoses. These artifacts may simulate pathologies on ECG's in healthy patients and result in long-term unnecessary or even deleterious treatments. On the other hand, to consider an arrhythmia as an artifact, may carry even worse consequences. Figure 2Confirmation of polymorphic ventricular tachycardia "torsades des pointes" type due to the absence of arterial pulse and an abrupt drop in systemic arterial pressure.

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