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ECG Interpretation

The upper ECG shows:

• Sinus rhythm, rate 64/min
• Short PR interval, best seen in leads V4–V5
• Normal axis
• Dominant R waves in lead V1
• Slurred upstroke (delta wave) in the QRS complexes

The lower ECG (rhythm strip) shows:

• A broad complex tachycardia
• Rate about 230/min
• The rhythm is irregular
• There is a slurred upstroke in some of the beats, suggesting pre-excitation

Clinical Interpretation

This is the Wolff–Parkinson–White (WPW) syndrome, involving a short PR interval and a widened QRS complex. This pattern, with a dominant R wave in lead V1 and where there is a left-sided accessory pathway, is called ‘type A’. It can easily be mistaken for right ventricular hypertrophy.

The patient’s palpitations are due to atrial fibrillation; an irregular broad complex tachycardia is characteristic of atrial fibrillation in the WPW syndrome.

What to do ?

Atrial fibrillation in association with the WPW syndrome is extremely dangerous. The patient needs an immediate electrophysiological study with a view to ablation of the accessory pathway.

• READ MORE:
  • Atrial Fibrillation in the Wolff-Parkinson-White (WPW) Syndrome
  • Management of Atrial Fibrillation (AF) with Rapid Ventricular Response (RVR)
• Similar Cases:
  • ECG Case 107: Atrial Fibrillation and WPW Syndrome
  • ECG Case 80: Atrial Fibrillation and WPW Syndrome
  • ECG Case 71: Atrial fibrillation with RVR, LAFB and Acute Anterolateral STEMI
  • ECG Case 66: Atrial Fibrillation with an Uncontrolled Ventricular Rate
  • ECG Case 59: Atrial Fibrillation with Rapid Ventricular Response (RVR) and Diffuse Subendocardial Ischemia