Ive had two procedures and going in for a 3 procedure at Royal Melbourne later this year… Still getting 204at rest but strangely i am able to control things a little more…If i sleep on side non heart side it takes off to about 186bpm but as soon as i turn over and lay on my heart side it almost immediately reverts back to 90bpm….Are the extra pathway being crushed by body weight on heart side and freely hanging by gravity and exciting atrium when laying on right side..????

Does Metoprolol help?

Yep. My wife does that procedure and it's quite amazing. There aren't too many chronic diseases in medicine that can be cured in a single day.

There's not necessarily an abundance of premature beats in patients with an accessory pathway (i.e. the WPW pattern), they will increase the probability that an arrhythmia is triggered. Intervention is only needed for patients who are experiencing arrhythmias - which is ablation in geographic regions where this is available, and medications where it's not.

Yes - this is on the list of topics I still need to cover in this series!

​@@StrongMed Thank you so much! you have a phenomenal way of explaining concepts.

You are top .nice and clear

If it was unusually prominent, and the accessory pathway was in a location within the heart where the delta waves were most prominent in the limb leads, I can certainly imagine being able to diagnose this from a conventional 5 lead telemetry system in some patients. However, it will be easier to identify from a 12 lead EKG.

@@StrongMed None of the leads would be on the limbs in a 5 lead. They'd be on the upper and lower chest and then in the center so I'm assuming you wouldn't be able to see it on the heart monitor. Right?

No, WPW does not usually show in all leads, and there are no specific leads to look at more so than the others. The delta waves can show up anywhere, depending upon the location of the pathway. The video gives a couple of examples of how to localized the pathway from about 6:00 to 11:00.

It seems like, from the examples I have seen, the delta wave is most often found in aVL and lead II. Is this correct?

Up

The WPW pattern has an estimated prevalence of ~1/500 people, and only a fraction of those with the WPW pattern on EKG actually develop arrhythmias. In my routine practice as a hospitalist (~16 weeks of inpatient wards/year), I encounter an EKG of probable AVRT in my own patients < 1x/year. Though that may be skewed by the fact that my clinical work is at a VA, where the average patient age is above the age when WPW is typically diagnosed. I don't think I mention this in the video, but the prevalence of orthodromic AVRT >> antidromic AVRT. My wife is an electrophysiologist, and when I asked her if she had any good examples of EKGs showing antidromic AVRT that I could incorporate into the video, she didn't. Ablation is by far the best way to treat WPW, and is very effective. Unfortunately, this therapy is not available in many places in the world, where they still rely on medications which prevent arrhythmias by either suppressing the premature beats which trigger AVRT, and/or by altering the electrical properties of the bypass tract. In a couple videos down the line, I'll be doing one on anti-arrhythmics, and will cover pharmacologic therapy for WPW.

¯\_(ツ)_/¯

Dr. Eric mentioned this same question on his video on waves, segments and interval. FYI in russia, they call PQ interval.

"Concealed WPW" refers to the situation in which a patient has an accessory pathway that directly connects the atria and the ventricles, but which is only capable of retrograde conduction under normal circumstances. Therefore, there is no delta wave on resting ECG. In contrast, the "WPW pattern" on ECG requires a delta wave by definition. WPW syndrome = WPW pattern + symptoms related to tachyarrhythmias. While a significant number of asymptomatic patients are incidentally found to have the WPW pattern on ECG, it's not known how many asymptomatic patients have a "concealed" WPW pathway since their ECGs in sinus rhythm look normal, and they would only have the accessory pathway identified during an EP study if they were symptomatic.

@@StrongMed Thanks for the reply. So when a WPW can only conduct retrogradely, why call it a WPW? I'm just really trying to understand the language and concepts accurately.