Ventricular Preexcitation of Every Other Beat?

K. Wang, MD


October 15, 2014


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]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.