Manifestations of disease will only be evident when tachyarrhythmias arise. Direct conduction from atria to ventricles via the accessory pathway, bypassing the AV node, seen with atrial fibrillation of atrial flutter in conjunction with WPWġ5% of cases of WPW exhibit retrograde conduction only – as such, they are a “concealed pathway” on the ECG during sinus rhythm.Formation of a reentry circuit involving the accessory pathway, termed atrioventricular reentry tachycardias (AVRT). ![]() The presence of an accessory pathway predisposes patients to tachyarrhythmia formation. Our patient above has a type B pattern – a dominant S wave in V1 indicates a right-sided accessory pathway. The type A pattern is associated with a left-sided accessory pathway and manifests a dominant R wave in V1 that may mimic right ventricular hypertrophy. There are two types of precordial patterns seen on the sinus rhythm ECG – type A and type B. When there is abnormal depolarisation there should be abnormal repolarisation - hence the presence of T-wave inversion and ST elevation and/or depression, which can often mimic Occlusion Myocardial Infarction (OMI). Note that tall R waves may mimic ventricular hypertrophy but are simply a result of abnormal depolarisation through an accessory pathway. ![]() in the opposite direction to the major component of the QRS complex ST-segment and T-wave discordant changes – i.e.
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