Which finding on ECG suggests antidromic circus movement tachycardias (CMTs) in Wolff-Parkinson-White (WPW) syndrome?

Updated: Jan 08, 2017
  • Author: Christopher R Ellis, MD, FACC, FHRS; Chief Editor: Mikhael F El-Chami, MD  more...
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Answer

Antidromic CMTs are wide and potentially faster because of the relatively short refractory period of most APs. They are termed antidromic because antegrade transmission occurs down the AP from the atria to the ventricles, creating preexcitation of the ventricle adjacent to the AP. These dysrhythmias are regular due to the nature of the circus movement. They are likely to have the classic delta wave appearance of the QRS on the resting ECG.

Differential diagnoses include VT, which also is regular (unless it is torsade de pointes) or PSVT with aberrancy. One should initially consider any regular wide-complex tachycardia to be VT until proven otherwise.


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