Electrocardiogram of a 46 year-old man with hypertension, Osler-Rendu-Weber syndrome (A-V malformation in the lungs) done prior to elective umbilical hernia repair.

Rate 65/min
PR 0.11 sec
QRS 0.14 sec
QT 0.43 sec
QTc 0.45 sec
QRS axis -40º

Interpretation: Abnormal ECG. Sinus rhythm. Short PR interval. Delta wave. Widening of the QRS complex and secondary ST-T changes. Preexcitation with right ventricular free wall accessory pathway.

Electocardiographic features of preexcitation (WPW - Wolff-Parkinson-White) syndrome include:
- PR interval less than 0.12 sec during sinus rhythm
- QRS complex exceeding 0.12 sec with a slowly rising onset in some leads - delta wave
- secondary ST-T changes, usually directed opposite to the delta wave and QRS vector.
The patient was asymptomatic with no palpitations, no arrhythmias, underwent uneventful surgery.

Diagram to localize the accessory pathway is presented below (from Braunwald, Zipes, Libby Heart Disease. A Textbook of Cardiovascular Medicine. 6th Edition 2001).

<< back to ECG Decoder