A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation

Thompson, Joel C.; Shah, Malay; Charnigo, Richard; Tackett, Andrea H.; Darrat, Yousef; Bailey, Alison L.; Delisle, Brian P.; Kakavand, Bahram; Biase, Luigi Di; Morales, Gustavo; Elayi, Claude S.

doi:10.1111/jce.12711

Cited by 2 publications

(1 citation statement)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since the patient did not have any history of coronary artery disease or any active chest pain, the presence of a significant Q wave associated with a WPW was considered to be part of the “pseudo-infarct pattern” related to activation of part or all the ventricles through the posterior insertion of the accessory pathway. Based on the surface ECG, the pathway appeared to be inserted posteriorly (Q wave in the inferior lead) and left-sided with an R/S ratio >0.5 to 1 [ 5 , 6 ]. Since the patient was experiencing a significant amount of SVT refractory to medications (recorded on a Holter monitor), the patient underwent an electrophysiology study and ablation of his accessory pathway.…”

Section: Case Reportmentioning

confidence: 99%

When a Pseudo-Infarct Electrocardiogram (ECG) Pattern in a Posterior Accessory (Wolff-Parkinson-White) Pathway Masks a True Inferior Infarct

et al. 2018

Self Cite

View full text Add to dashboard Cite

Patient: Male, 61Final Diagnosis: Wolff-Parkinson-White (WPW)Symptoms: PalpitationMedication: —Clinical Procedure: Ablation of accessory pathway of supra-ventricular tachycardiaSpecialty: CardiologyObjective:Rare co-existance of disease or pathologyBackground:Wolff-Parkinson-White (WPW) pattern is due to a pre-excitation leading to characteristic ECG changes in sinus rhythm as short PR interval, the presence of delta waves, wide QRS complexes, and potentially Q wave-T wave vector discordance (pseudo-infarct pattern). These later changes can mask the underlying ECG depolarizing solely through the His-Purkinje system. Our case highlights how the ECG of a WPW pattern with a pseudo-infarct pattern can in fact mask a true infarct on the underlying ECG without pre-excitation.Case Report:A 61-year-old diabetic man with a recent history of supra-ventricular tachycardia (SVT) presented with the ECG characteristic of a Wolff-Parkinson-White pattern i-e short PR interval of 0.10 s (<0.12 s) and the presence of delta waves in sinus rhythm. In addition, there was a wide significant Q wave in the inferior leads meeting the criteria for significant and pathologic Q waves, related to the pre-excitation and known as a pseudo-infarct pattern. The patient underwent successful ablation of his left inferoseptal accessory pathway. The pre-excitation pattern (short PR and delta wave) disappeared after successful ablation revealed a narrower Q wave in inferior leads, likely from unexpected true old inferior infarction, which was later confirmed by 2D echocardiogram and nuclear stress test (fixed inferior defect).Conclusions:The presence of pseudo-infarct pattern due to a WPW does not always preclude the presence of underlying true infarct pattern, especially in the presence of coronary artery disease risk factors.

show abstract

Section: Case Reportmentioning

confidence: 99%

When a Pseudo-Infarct Electrocardiogram (ECG) Pattern in a Posterior Accessory (Wolff-Parkinson-White) Pathway Masks a True Inferior Infarct

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

Delta wave notching time is associated with accessory pathway localization in patients with Wolff-Parkinson-White syndrome

İçen¹,

Dönmez²,

Koca³

et al. 2018

J Interv Card Electrophysiol

View full text Add to dashboard Cite

show abstract

A Practical ECG Criterion to Unmask Left Accessory AV Connections in Patients With Subtle Preexcitation

Abstract: In symptomatic patients, combining the R/S ratio (≥ 0.5) in lead V1 with the classic preexcitation pattern on ECG markedly improved the sensitivity to diagnose left-sided AV-connections. This ratio may be particularly useful among patients lacking obvious preexcitation.

Cited by 2 publications

References 24 publications

When a Pseudo-Infarct Electrocardiogram (ECG) Pattern in a Posterior Accessory (Wolff-Parkinson-White) Pathway Masks a True Inferior Infarct

When a Pseudo-Infarct Electrocardiogram (ECG) Pattern in a Posterior Accessory (Wolff-Parkinson-White) Pathway Masks a True Inferior Infarct

Delta wave notching time is associated with accessory pathway localization in patients with Wolff-Parkinson-White syndrome

Contact Info

Product

Resources

About