ecg: reciprocating tachycardia
TRANSCRIPT
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ECG OF THE WEEK
Prof.Dr.MAHESH KUMAR’s unitDr.T. Balamurugan, PG
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46 year old female, admitted in ICCU with c/o palpitation----------- 4 hrs
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ECG
Heart rate- 190 Rhythm regular QRS duration- 60 ms R-R interval –regular & 320 ms P’ visible after QRS complexes R-P’ interval 80 ms (shortened)
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DIAGNOSIS
Narrow complex tachycardia
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Heart rate- 72/min Rhythm- regular QRS duration- 130 ms Slurred upstroke of QRS complex (delta
wave) P-R interval –90 ms (shortened) Q-T interval –480 ms
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PAROXYSMAL TACHYCARDIAS IN WPW SYNDROME
AV junctional re-entry
tachycardia
•AV Junctional using anamolous pathway- 1) Orthodromic 2) antidromic•Intra nodal pathway (micro re-entry)•AV junctionl re-entry involving two anamolous pathways•Macro entry involving two anamolous pathways
Atrial tachyarrhythmi
a
•Atrial tachycardia•Atrial flutter•Atrial fibrillation
Ventricular tachycardia
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MECHANISM OF RECIPROCATING TACHYCARDIA IN WPW SYNDROME
Sinus impulse activating atria (normal P wave)
conduction of sinus impulse
through bypass may be blocked, but conducted in usual manner through AV node, activating ventricles (normal QRS wave)
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activation front on reaching ventricles, conducted retrogradely, activating
atria retrogradely
Retrograde P’ wave
Inverted P’ wave in L2,3,aVF
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Returning reciprocal impulse, after reaching atria
Conducted anterogradely through normal AV nodal conduction, activating
ventricles
Re-enter bypass once again, activating atria……………
Reciprocating tachycardia
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Since anterograde conduction to the ventricles occurs through normal pathway, pre-excitation doesn’t take place & delta waves not recordable
When ECG recorded during this phase, manifestations of WPW syndrome not evident in ECG ‘Concealed WPW syndrome’
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THANK YOU