Ventricular Preexcitation of Every Other Beat?

K. Wang, MD

October 15, 2014

Discussion

The wide complexes in V4-6 indeed suggest ventricular preexcitation (short PR interval, slurred upstroke of delta waves). However, observations of the rhythm strips of VI, II, and V5, from right to left, show that the P wave in front of the wide QRS complex gradually marches into the QRS rather than maintaining a fixed relationship. Therefore, these are not ventricular preexcited beats but simply a ventricular bigeminy which happens to have a "pseudo" delta wave.^[1] Some QRS complexes have a slurred upstroke without being preexcited, which I would call a "pseudo" delta wave.^[1]

References

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Ventricular Preexcitation of Every Other Beat?

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Authors and Disclosures

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K. Wang, MD

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