Wolff-Parkinson-White syndrome classification scheme: Difference between revisions
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==Classification== | ==Classification== | ||
=== | ===Classification Based on the Type of Conduction=== | ||
===Classification Based on the ECG Findings=== | |||
This classification is based on the side where the accessory pathway is established. The type A preexcitation presents the accessory pathway in the left side of the heart (comunicates the left [[atrium]] with the left [[ventricle]]). The type B preexcitation presents the accessory pathway in the right side of the heart (comunicates the right [[atrium]] with the right [[ventricle]]). Each type of preexcitation presents its own electrocardiographyc characteristics.<ref name="pmidhttp://dx.doi.org/10.1016/j.hrthm.2013.11.018">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/j.hrthm.2013.11.018 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | This classification is based on the side where the accessory pathway is established. The type A preexcitation presents the accessory pathway in the left side of the heart (comunicates the left [[atrium]] with the left [[ventricle]]). The type B preexcitation presents the accessory pathway in the right side of the heart (comunicates the right [[atrium]] with the right [[ventricle]]). Each type of preexcitation presents its own electrocardiographyc characteristics.<ref name="pmidhttp://dx.doi.org/10.1016/j.hrthm.2013.11.018">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=http://dx.doi.org/10.1016/j.hrthm.2013.11.018 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | ||
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#* May resemble an abnormal Q wave in the right precordial leads and be mistaken for an [[Acute MI|anterior MI]]. | #* May resemble an abnormal Q wave in the right precordial leads and be mistaken for an [[Acute MI|anterior MI]]. | ||
#* In both type A and B there may be abnormal q waves in leads 2, 3 and aVF. | #* In both type A and B there may be abnormal q waves in leads 2, 3 and aVF. | ||
===Classification Based on the Type of AVRT=== | |||
===Variants of WPW=== | ===Variants of WPW=== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Classification
Classification Based on the Type of Conduction
Classification Based on the ECG Findings
This classification is based on the side where the accessory pathway is established. The type A preexcitation presents the accessory pathway in the left side of the heart (comunicates the left atrium with the left ventricle). The type B preexcitation presents the accessory pathway in the right side of the heart (comunicates the right atrium with the right ventricle). Each type of preexcitation presents its own electrocardiographyc characteristics.[1]
- Type A:
- Prominent R wave in lead V1 and V2.
- It has been found at EP studies that these patients have early activation of the left ventricle.
- Generally V1 shows either a notched R wave or RS or Rsr' deflection.
- Mimics a posterior MI, RVH.
- Type B:
- Prominent S wave deflection in the right precordial leads, and upright R waves in the lateral precordial leads.
- EP studies have showed that this form of WPW syndromes is due to early activation of the lateral aspect of the right ventricle
- This form is more common.
- May resemble an abnormal Q wave in the right precordial leads and be mistaken for an anterior MI.
- In both type A and B there may be abnormal q waves in leads 2, 3 and aVF.
Classification Based on the Type of AVRT
Variants of WPW
Lown-Ganong-Levine Syndrome (LGL)
- There is a short PR interval, but no delta wave
- LGL is due to intranodal bypass tracts (i.e. there is conduction down the James fibers)
- Normal QRS duration
- PR less than 0.12 seconds
- Normal P wave
Mahaim Type Preexcitation
- This form of pre-excitation is due to nodoventricular, nodofascicular or fasciculoventricular connections
- The impulse may travel through the AV node normally and this may then be followed by premature conduction to the basal ventricular myocardium
- There is a delta wave with a normal PR interval
- Rarer than WPW or LGL
- In older patients there can be a prolonged conduction down the accessory pathway resulting in a normal PR interval in the presence of WPW which is tough to distinguish from Mahaim fibers
References
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID http://dx.doi.org/10.1016/j.hrthm.2013.11.018 Check
|pmid=value (help).