wpw which side
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WolfWolf--ParkinsonParkinson--WhiteWhite
S ndromeS ndromeRight or Left?Right or Left?
Dr. Hatem KholeifDr. Hatem Kholeif
-Azhar University; Cairo
Professor of CardiologyProfessor of Cardiology
AlAl-Azhar University; Cairo
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Aim ..Aim ..
lead ECG without-lead ECG withoutTo Know how to localize the accessoryTo Know how to localize the accessorypathway from 12pathway from 12-usin an al orithm.usin an al orithm.
during electrophysiological study.during electrophysiological study.Localization of accessory pathwayLocalization of accessory pathway
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WPWWPW
from the ventricles exceheart the A are isolated electricallyheart the A are isolated electricallyNormally during development of theNormally during development of the
from the ventricles exce t at AVN.t at AVN.
mitral connection).-mitral connection).(except at aorto-(except at aortoA to V anywhere across the AV ringA to V anywhere across the AV ringSometimes a muscle bundle attach theSometimes a muscle bundle attach the
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Localization of bypass tractLocalization of bypass tractin the WPW from the ECGin the WPW from the ECG
Rosenbaum (1945) .. Type A & BRosenbaum (1945) .. Type A & B
QRS > 120 msQRS > 120 ms
Analysis of delta wave in the frontal &Analysis of delta wave in the frontal &
frontal & horizontal planes.frontal & horizontal planes.
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StepsSteps ....
as delta wave in V1as delta wave in V.Look at main QRS deflection in V11.Look at main QRS deflection in V1 1--33 as wellas well
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Positive with Left sidedPositive with Left sided
Ne ative with ri ht sidedNe ative with ri ht sided
. Transitional zone3. Transitional zone
negative .. Posteriornegative .. Posterior
2. Inferior leads; LII, III & aVF2. Inferior leads; LII, III & aVF
Positive .. AnteriorPositive .. Anterior3
before Vbefore V3 .. Ri3 ght Septal.. Rig
.. Right lateral4 .. Right lateral
ht Septal
after Vafter V4
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Differentiating right from left posteroseptal ..Differentiating right from left posteroseptal ..
MM--mode echomode echo
A dominant septal notch .. Right sidedA dominant septal notch .. Right sided
pos er or wa no c .. e s epos er or wa no c .. e s e
These notches disappear .. AblationThese notches disappear .. Ablation
[Hina et al.([Hina et al.(19991999) Heart;) Heart; 8282::731731--739739]]
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Localization of the accessoryLocalization of the accessorypathway during EPSpathway during EPS
From atrial sideFrom atrial side
Distal or mid CS .. Left sidedDistal or mid CS .. Left sided
Shortest VA during tachycardiaShortest VA during tachycardia
His .. Right anteroseptalHis .. Right anteroseptal
HRA .. Right free wallHRA .. Right free wall
Proximal CS .. Posteroseptal.Proximal CS .. Posteroseptal.
Unipolar recording (if manifested)Unipolar recording (if manifested)
CS precedes His > 25CS precedes His > 25 ms .. Left sidedms .. Left sided
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Localization of the accessory pathway during EPSLocalization of the accessory pathway during EPSContinuedContinued
From ventricular sideFrom ventricular side
Earliest V in relation to delta wave.Earliest V in relation to delta wave.
. .
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AP prolongs the CL of tachycardiaAP prolongs the CL of tachycardia
Development of BBB ipsilateral to theDevelopment of BBB ipsilateral to the
3030 ms.ms.
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