Anomalous pathway graphics and classification charts via The Cardiac Technologist Blog
Localization of the accessory pathway in WPW by surface ECG can be undertaken algorithmicly, through direct analysis of delta-wave vectors, or by visual familiarity with various WPW signatures.
Two algorithmic approaches are:
- Milstein (1987) and Aruda (1998):Milstein S, Sharma AD, Guiraudon GM, and Klein GJ. An algorithm for the electrocardiographic localization of accessory pathways in the Wolff-Parkinson-White syndrome. Pacing Clin Electrophysiol 1987 May; 10(3 Pt 1) 555-63. pmid:2440006.
- Arruda MS, McClelland JH, Wang X, Beckman KJ, Widman LE, Gonzalez MD, Nakagawa H, Lazzara R, and Jackman WM.Development and validation of an ECG algorithm for identifying accessory pathway ablation site in Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 1998 Jan; 9(1) 2-12.pmid:9475572.
A free electronic interface to both of these algorithms as well as numerous other ECG related algorithms (VT, SVT, ect.) is available through the iPhone application EP Tools. Visual flow-chart diagrams for these algorithms as well as a discussion of WPW pathophysiology can be found at ECGPedia.
Regarding vectorography, an extensive discussion of this method can be found on the EP Fellow blog.
There are many superior case studies exploring WPW, its presentations, and its treatment strategies.
From EMS 12-Lead:
- “63 Year-old female complaining of chest pressure.” WPW with AF and concealed accessory pathway post cardioversion.
- “17 Year-old male with chest pain and palpitations.” WPW with AF; discussion parts 1 and 2.
- “WPW as STEMI mimic.”
From Dr. Stephen Smith:
- “WPW mimicking and obscuring acute MI.” Five cases– mimics, WPW with AMI, and WPW concealing AMI.
- “WCT: 2 cases.” Diagnosis and management. WPW with AF.
- “WCT converted and subsequent 12-lead with STE due to WPW.”