Practice ECG 17
Here is another case of WPW. Do you see the delta wave clearly? It appears in every lead except aVR. Note that the PR interval is not shortened in this patient. Approximately 12% of patients do not have a shortened PR interval as part of their WPW complex.
For the more advanced readers, this is WPW type A with a positive delta wave in V1 and a pseudoinfarct pattern in the inferior leads. The scooped ST segments suggest digoxin therapy.
Look at the eighth complex; it appears similar to, but wider than, the other complexes. There is also the beginning of a P wave right before the complex. One elegant explanation is that this is an aberrantly conducted APC with the ectopic pacer lying near the Kent bundle. This would produce an earlier start to the delta wave and, hence, a longer delta component to the complex.
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