ECG: UNDERSTANDING

ACCELERATED
CONDUCTION
Dr. Krishnendu Maity
BHMS [Calcutta] MD (Hom. Repertory) [Pune]
Professor & HOD, Dept. of Medicine
Teaching Medicine, Materia & Repertory
Lal Bahadur Shastri Homopathic Medical College,
Bhopal 26 (MP)
Email: post.krishnendu2010@ymail.com

INTRODUCTION
There are 02 types of accelerated conductions
from the atrium to the ventricles; viz.
Wolff-Parkinson-White (WPW) Syndrome /
Pre-excitation Syndrome.
Lown-Ganong-Levine (LGL) Syndrome.

WPW SYNDROME
Bundle of Kent by-pass the AV node or by
Mahaim fibes which goes from Bundle of His
to Ventricular Septum. The pre-excitation of
Bundle of Kent is called WPW Syndrome.
The atrial impulse passes through the normal
path of conduction and also through the anterior
intra-nodal fibre [Bachmanns fibre / Bundle of
Kent], simultaneously.

CLASSIFICATION OF
WPW SYNDROME
WPW Syndrome is of 02 types ---Type A: where excitation travels along Left
accessory pathway giving rise to RVH /
RBBB.
Type B: where excitation travels along Right
lateral accessory pathways giving rise to
LBBB. If it is associated with Cyanotic CHD
Ebsteins Anomaly is diagnosed.

ECG OF WPW Syndrome

Short P-R interval [less than 0.12 sec.].

Wide QRS complex.
Appearance of -wave / slurred upstroke of QRS.
Normal P-wave axis.

CAUSES OF WPW
Syndrome
Normal individuals.
Myocardial Infarction.
Acute Rheumatic Fever.
CHD Ebsteins Anomaly.
Cardiac catheterization / Surgical manipulation
of Heart.
Hypertrophic Sub-aortic Stenosis.
Idiopathic Cardiomyopathy.
Thyrotoxicosis.

WPW SYNDROME WITH

ATRIAL FIBRILLATION

Irregularly irregular, wide complex tachycardia.

Impulses from the atria are conducted to the ventricles via either

both the AV node and Accessory pathway producing a broad

fusion complex.

or just AV node producing a narrow complex (without -wave).

or just Accessory pathway producing a very broad 'pure' - wave.

People who develop this rhythm and have very short R-R intervals
are at higher risk of VF.

LGL Syndrome
James Accesory Tract / Bundle of James by-pass
the upper part of the AV node. The pre-excitation
of the Bundle of James is called LGL Syndrome.
The artrial impulse preferentially passes through
the posterior intra-nodal fibre [Thorels fibre /
Bundle of James] and conducted to His Bundle.
Pateints of this syndrome are prone to develop
Supra-ventricular arrhythmias, ventricular
tachycardia & Ventricular fibrillation.

ECG OF LGL Syndrome

Short P-R interval.
Normal QRS complex.
Normal T-wave.
No -wave.

LGL SYNDROME WITH

ATRIAL FIBRILLATION

Short PR interval [less than 3 small squares].

No -wave.

REFERENCES
1. Das, Dr. P. C. Textbook of Medicine [Reprint
April, 1995; Current Book International].
2. Ganong, Dr. William F. Review of Medical
Physiology (22ND edition, 2005; McGraw Hill).
3. Mehta, Dr. P. J. Understanding ECG [Reprint
6TH edition, 2008; The National Book Depot].

THANKS TO ALL ------