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ECG: UNDERSTANDING

ACCELERATED
CONDUCTION
Dr. Krishnendu Maity
BHMS [Calcutta] MD (Hom. Repertory)
[Pune]
Associate Professor & HOD I/c, Dept. of
Medicine
Teaching Medicine, Materia & Repertory
Lal Bahadur Shastri Homœopathic Medical
INTRODUCTION

There are 02 types of accelerated conductions from


the atrium to the ventricles; viz.

Wolff-Parkinson-White (WPW) Syndrome / Pre-


excitation Syndrome.

Lown-Ganong-Levine (LGL) Syndrome.


WPW SYNDROME
Bundle of Kent by-pass the AV node or by
Mahaim fibes – which goes from Bundle of His to
Ventricular Septum. The pre-excitation of ‘Bundle
of Kent’ is called WPW Syndrome.
The atrial impulse passes through the normal
path of conduction and also through the anterior
intra-nodal fibre [Bachmann’s fibre / Bundle of
Kent], simultaneously.
CLASSIFICATION OF
WPW SYNDROME
WPW Syndrome is of 02 types ----

Type A: where excitation travels along Left


accessory pathway – giving rise to RVH / RBBB.
Type B: where excitation travels along Right
lateral accessory pathways – giving rise to
LBBB. If it is associated with Cyanotic CHD –
Ebstein’s Anomaly is diagnosed.
ECG OF WPW Syndrome

Short P-R interval [less than 0.12 sec.].


Wide QRS complex.
Appearance of δ -wave / slurred upstroke of QRS.
Normal P-wave axis.
CAUSES OF WPW
Syndrome
Normal individuals.
Myocardial Infarction.
Acute Rheumatic Fever.
CHD – Ebstein’s Anomaly.
Cardiac catheterization / Surgical
manipulation of Heart.
Hypertrophic Sub-aortic Stenosis.
Idiopathic Cardiomyopathy.
Thyrotoxicosis.
WPW SYNDROME WITH
ATRIAL FIBRILLATION

Irregularly irregular, wide complex tachycardia.


Impulses from the atria are conducted to the ventricles via
either
 both the AV node and Accessory pathway producing a

broad fusion complex.


 or just AV node producing a narrow complex (without δ -

wave).
 or just Accessory pathway producing a very broad 'pure' δ -

wave.
People who develop this rhythm and have very short R-R
intervals are at higher risk of VF.
LGL Syndrome
James Accesory Tract / Bundle of James by-pass the upper
part of the AV node. The pre-excitation of the ‘Bundle of
James’ is called LGL Syndrome.
The artrial impulse preferentially passes through the
posterior intra-nodal fibre [Thorel’s fibre / Bundle of
James] and conducted to His Bundle.
Pateints of this syndrome are prone to develop Supra-
ventricular arrhythmias, ventricular tachycardia &
Ventricular fibrillation.
ECG OF LGL Syndrome
Short P-R interval.
Normal QRS complex.
Normal T-wave.
No δ -wave.
LGL SYNDROME WITH
ATRIAL FIBRILLATION

Short PR interval [less than 3 small squares].


No δ -wave.
REFERENCES
1. Das, Dr. P. C. – Textbook of Medicine [Reprint April,
1995; Current Book International].
2. Ganong, Dr. William F. – Review of Medical Physiology
(22ND edition, 2005; McGraw Hill).
3. Mehta, Dr. P. J. – Understanding ECG [Reprint 6TH
edition, 2008; The National Book Depot].
THANKS TO ALL ------