ecg accessory-pathway 
Dr. Smith's ECG Blog
MAY 7, 2024
Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves. The two ECGs above were texted to me with the text: "Young Guy came in in SVT but now in and out of irregular wide complex tachycardia. -- not sure if polymorphic VT vs. a fib with WPW."
ALiEM
NOVEMBER 6, 2023
Wolf-Parkison-White Syndrome (WPW) Case Question: What are the characteristic ECG findings of this condition and how is this condition managed? WPW is a pre-excitation syndrome characterized by an accessory pathway caused by a congenital failure of cells to resorb near the AV valves. Short PR interval (< 0.12 PMID: 8194348.
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Dr. Smith's ECG Blog
JUNE 11, 2023
Here is his triage ECG: He had several more ECGs taken in the resuscitation bay over the next few minutes: What do you think? The ECGs show a wide complex, irregularly irregular tachycardia. If you eliminate normal conduction with adenosine, then the beat is VERY wide because it is ALL through the accessory pathway.
Dr. Smith's ECG Blog
JUNE 28, 2023
He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. Here is the ECG: What do you think? Thus, this is more likely: 1) antidromic AVRT (down through accessoary pathway and up through the AV node OR 2) standard VT which begins in myocardium and thus has a wider initial part of the QRS.
Dr. Smith's ECG Blog
NOVEMBER 19, 2022
I think it is easy to see now that the QRS is widened because of an accessory conduction pathway. In context of our original EKG, the patient appears to be alternating conduction through the AV node and accessory pathway - a condition previously described as Wolf-Parkinson-White Alternans.[1] But many missed it.
Dr. Smith's ECG Blog
OCTOBER 13, 2022
In this case there are tall R waves in precordial leads (from a left sided accessory pathway), which are followed by discordant ST depression and T wave inversion. There were no prior ECGs, the first ECG was signed off as unremarkable, and the patient waited to be seen. Here’s the third ECG, 30 minutes after the second.
Dr. Smith's ECG Blog
MAY 14, 2022
Here is his ED ECG: Regular Wide Complex Tachycardia at a rate of 229 First : What do you want to do? Next : What do you think is the ECG diagnosis? ECG analysis: T his is a regular wide complex tachycardia. Here is the post cardioversion ECG (texted to me): This what I texted back: "Could be WPW. Antidromic WPW).
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