I had an ablation done at ten years old after my heart rate went up to 170 out of nowhere. Now I am 21 learning physiology and this is fascinating!!! I wish I knew more details about my accessory pathway but I do not have access to my records.
I was born with WPW syndrome, but was never diagnosed on any ECG, it had never shown until my 20s which is about 4 years ago when one day I was just taking to the phone and suddenly I felt having a bit of tachycardia, but not very fast, was about 120-130bpm, but I could feel it was arrhythmia. So after the first symptoms occurred, the pathway showed in the ECG for the first time. My doctor saw all the exams, and then I went to the Electrophysiologist to do the examination and possible ablation. The basic rhythm was Sinus but with visible accessory pathway, and during the Electrophysiological study, the doctor induced atrial fibrillation, to see how the heart responded but it stopped on its own. We had to do 2 procedures because the first time the pathway wasn't completely destroyed so a second procedure was required to destroy the tissue. Ever since, I never had any problems just sometimes I have those extra systoles which feel like a "stopping" for a split second with the feeling of slamming a door, but the doctor said that these are common among 80% of humans but they scare me.
Ive had two procedures and going in for a 3 procedure at Royal Melbourne later this year… Still getting 204at rest but strangely i am able to control things a little more…If i sleep on side non heart side it takes off to about 186bpm but as soon as i turn over and lay on my heart side it almost immediately reverts back to 90bpm….Are the extra pathway being crushed by body weight on heart side and freely hanging by gravity and exciting atrium when laying on right side..????
Thank you! I have WPW and wanted more info than my cardiologist gave me, which was that I "had an extra wire"! Not that he was wrong, but I just was curious :)
Thank you, this helped me understand what is happening with my body. I was notified a few days ago that I am WPW syndrome and have since been referred to both an electrophysiologist and a general doctor after a panic attack apparently tripped me into palpitations and I felt the need to call 911.
I had WPW until a week ago, I had it operated and removed with ablation, its GONE ! If your hospital do the ablations, dont wait ! its relatively easy and safe procedure. Palpitations can be life treatining if you will be older and get any other heart problems so dont wait and remove that extra path. Technology is great nowdays.
Dr Strong, thank you so much! this is a very helpful vd but I believe there's lot of imp details regarding the differentiation between AVNRT and AVRT subtypes that are missing. I wish you can do separate vd on this topic
Thank you. What I understand is these are some kind of arrhithmia in which ventricle contracts early, abundance of premature beats and need some kind of intervention
There's not necessarily an abundance of premature beats in patients with an accessory pathway (i.e. the WPW pattern), they will increase the probability that an arrhythmia is triggered. Intervention is only needed for patients who are experiencing arrhythmias - which is ablation in geographic regions where this is available, and medications where it's not.
Eric, can please clarify the meaning of the RP interval? does it relate to the ventricular depolarization that occurs just before the retrograde wave depolarozes the atria or to the ventricular depolarization that occurs when the retrograde wave reaches the junction where it spread simultaneously to the av node and the atria?
Does WPW show in all leads? Or do you look at specific leads to locate it? If so, can you figure out the approximate location of the accessory pathway by what leads it shows in?
No, WPW does not usually show in all leads, and there are no specific leads to look at more so than the others. The delta waves can show up anywhere, depending upon the location of the pathway. The video gives a couple of examples of how to localized the pathway from about 6:00 to 11:00.
Hey ! Greetings from Poland . U helps a lot with my studying medicine on last year. Just one question ... If I understood well, in AVRT we WON'T have any sympthoms on EKG like delta wave because impulse goes back up in accessory pathway, while in WPW without arrytmias or others than WPW I will see delta wave because impulse goes down this accessory pathway ?
If it was unusually prominent, and the accessory pathway was in a location within the heart where the delta waves were most prominent in the limb leads, I can certainly imagine being able to diagnose this from a conventional 5 lead telemetry system in some patients. However, it will be easier to identify from a 12 lead EKG.
@@StrongMed None of the leads would be on the limbs in a 5 lead. They'd be on the upper and lower chest and then in the center so I'm assuming you wouldn't be able to see it on the heart monitor. Right?
Thank you Dr. Strong, I am a 2nd year medical student going on to 3rd, how prevalent is WPW in practice? Is ablation the only sure way to treat symptomatic WPW? Thank you for the awesome video series, D.O. Class 2019
The WPW pattern has an estimated prevalence of ~1/500 people, and only a fraction of those with the WPW pattern on EKG actually develop arrhythmias. In my routine practice as a hospitalist (~16 weeks of inpatient wards/year), I encounter an EKG of probable AVRT in my own patients < 1x/year. Though that may be skewed by the fact that my clinical work is at a VA, where the average patient age is above the age when WPW is typically diagnosed. I don't think I mention this in the video, but the prevalence of orthodromic AVRT >> antidromic AVRT. My wife is an electrophysiologist, and when I asked her if she had any good examples of EKGs showing antidromic AVRT that I could incorporate into the video, she didn't. Ablation is by far the best way to treat WPW, and is very effective. Unfortunately, this therapy is not available in many places in the world, where they still rely on medications which prevent arrhythmias by either suppressing the premature beats which trigger AVRT, and/or by altering the electrical properties of the bypass tract. In a couple videos down the line, I'll be doing one on anti-arrhythmics, and will cover pharmacologic therapy for WPW.
I'm new to EP, how can you have a concealed WPW???? I thought a criteria for WPW was preexcitation with a manifest delta wave??? Am I missing something here???
"Concealed WPW" refers to the situation in which a patient has an accessory pathway that directly connects the atria and the ventricles, but which is only capable of retrograde conduction under normal circumstances. Therefore, there is no delta wave on resting ECG. In contrast, the "WPW pattern" on ECG requires a delta wave by definition. WPW syndrome = WPW pattern + symptoms related to tachyarrhythmias. While a significant number of asymptomatic patients are incidentally found to have the WPW pattern on ECG, it's not known how many asymptomatic patients have a "concealed" WPW pathway since their ECGs in sinus rhythm look normal, and they would only have the accessory pathway identified during an EP study if they were symptomatic.
@@StrongMed Thanks for the reply. So when a WPW can only conduct retrogradely, why call it a WPW? I'm just really trying to understand the language and concepts accurately.
You are a lifesaver!! The WPW description in my cardiology book is so messed up, I was so confused until I saw this. Thank you!
I had an ablation done at ten years old after my heart rate went up to 170 out of nowhere. Now I am 21 learning physiology and this is fascinating!!! I wish I knew more details about my accessory pathway but I do not have access to my records.
I was born with WPW syndrome, but was never diagnosed on any ECG, it had never shown until my 20s which is about 4 years ago when one day I was just taking to the phone and suddenly I felt having a bit of tachycardia, but not very fast, was about 120-130bpm, but I could feel it was arrhythmia. So after the first symptoms occurred, the pathway showed in the ECG for the first time. My doctor saw all the exams, and then I went to the Electrophysiologist to do the examination and possible ablation. The basic rhythm was Sinus but with visible accessory pathway, and during the Electrophysiological study, the doctor induced atrial fibrillation, to see how the heart responded but it stopped on its own. We had to do 2 procedures because the first time the pathway wasn't completely destroyed so a second procedure was required to destroy the tissue. Ever since, I never had any problems just sometimes I have those extra systoles which feel like a "stopping" for a split second with the feeling of slamming a door, but the doctor said that these are common among 80% of humans but they scare me.
Ive had two procedures and going in for a 3 procedure at Royal Melbourne later this year… Still getting 204at rest but strangely i am able to control things a little more…If i sleep on side non heart side it takes off to about 186bpm but as soon as i turn over and lay on my heart side it almost immediately reverts back to 90bpm….Are the extra pathway being crushed by body weight on heart side and freely hanging by gravity and exciting atrium when laying on right side..????
Thank you! I have WPW and wanted more info than my cardiologist gave me, which was that I "had an extra wire"! Not that he was wrong, but I just was curious :)
Great video. Very useful. Thanks! Cheers from Brazil.
Thank you, this helped me understand what is happening with my body. I was notified a few days ago that I am WPW syndrome and have since been referred to both an electrophysiologist and a general doctor after a panic attack apparently tripped me into palpitations and I felt the need to call 911.
Does Metoprolol help?
great work doctr . i am totally speechless
can you please add these new videos to the EKG playlist in channel to be more easy to access in future
Much more useful than my EKG Books ! Appreciate the the work you've done ! Thx a lot 😎😎😎
Great video, very informative. The leads V1 and II in the EKG for intermittent preexcitation have been switched.
I had WPW until a week ago, I had it operated and removed with ablation, its GONE !
If your hospital do the ablations, dont wait ! its relatively easy and safe procedure.
Palpitations can be life treatining if you will be older and get any other heart problems so dont wait and remove that extra path. Technology is great nowdays.
Yep. My wife does that procedure and it's quite amazing. There aren't too many chronic diseases in medicine that can be cured in a single day.
Nice work....تم التحميل
Very helpful. Thanks!
thankyou so so so much dr.eric ... you are the best
Thanks,exciting eleboration
Amazing !
Dr Strong, thank you so much! this is a very helpful vd but I believe there's lot of imp details regarding the differentiation between AVNRT and AVRT subtypes that are missing. I wish you can do separate vd on this topic
Yes - this is on the list of topics I still need to cover in this series!
@@StrongMed Thank you so much! you have a phenomenal way of explaining concepts.
Thank you. What I understand is these are some kind of arrhithmia in which ventricle contracts early, abundance of premature beats and need some kind of intervention
There's not necessarily an abundance of premature beats in patients with an accessory pathway (i.e. the WPW pattern), they will increase the probability that an arrhythmia is triggered. Intervention is only needed for patients who are experiencing arrhythmias - which is ablation in geographic regions where this is available, and medications where it's not.
Thank you Dr Strong
Great work and excellent doctor
doc you are awesome ......
thank you very much
can sleep be disturbed due to wpw syndrome?
1:18 정상적인 전기신호 이동 모습
1:48 정상적인 전기신호 이동 상태에서 점점
WPW 전기신호로 변천되어 가는 모습
2:45 델타 웨이브.
Helpful
Eric, can please clarify the meaning of the RP interval? does it relate to the ventricular depolarization that occurs just before the retrograde wave depolarozes the atria or to the ventricular depolarization that occurs when the retrograde wave reaches the junction where it spread simultaneously to the av node and the atria?
You are top .nice and clear
Thank you man , nice and comprehensive work
Does WPW show in all leads? Or do you look at specific leads to locate it? If so, can you figure out the approximate location of the accessory pathway by what leads it shows in?
No, WPW does not usually show in all leads, and there are no specific leads to look at more so than the others. The delta waves can show up anywhere, depending upon the location of the pathway. The video gives a couple of examples of how to localized the pathway from about 6:00 to 11:00.
It seems like, from the examples I have seen, the delta wave is most often found in aVL and lead II. Is this correct?
How do you differentiate typeA from typeB wpw,terms that are often used?
Hey ! Greetings from Poland . U helps a lot with my studying medicine on last year. Just one question ...
If I understood well, in AVRT we WON'T have any sympthoms on EKG like delta wave because impulse goes back up in accessory pathway, while in WPW without arrytmias or others than WPW I will see delta wave because impulse goes down this accessory pathway ?
Up
Can you see WPW on a regular 5 lead heart monitor or do you need an EKG with 12 leads to catch it?
If it was unusually prominent, and the accessory pathway was in a location within the heart where the delta waves were most prominent in the limb leads, I can certainly imagine being able to diagnose this from a conventional 5 lead telemetry system in some patients. However, it will be easier to identify from a 12 lead EKG.
@@StrongMed None of the leads would be on the limbs in a 5 lead. They'd be on the upper and lower chest and then in the center so I'm assuming you wouldn't be able to see it on the heart monitor. Right?
Tnx alot🙏🙏
You are the best :)
Just thanks a lot ....💙
Thank you Dr. Strong,
I am a 2nd year medical student going on to 3rd, how prevalent is WPW in practice?
Is ablation the only sure way to treat symptomatic WPW?
Thank you for the awesome video series,
D.O. Class 2019
The WPW pattern has an estimated prevalence of ~1/500 people, and only a fraction of those with the WPW pattern on EKG actually develop arrhythmias. In my routine practice as a hospitalist (~16 weeks of inpatient wards/year), I encounter an EKG of probable AVRT in my own patients < 1x/year. Though that may be skewed by the fact that my clinical work is at a VA, where the average patient age is above the age when WPW is typically diagnosed. I don't think I mention this in the video, but the prevalence of orthodromic AVRT >> antidromic AVRT. My wife is an electrophysiologist, and when I asked her if she had any good examples of EKGs showing antidromic AVRT that I could incorporate into the video, she didn't.
Ablation is by far the best way to treat WPW, and is very effective. Unfortunately, this therapy is not available in many places in the world, where they still rely on medications which prevent arrhythmias by either suppressing the premature beats which trigger AVRT, and/or by altering the electrical properties of the bypass tract. In a couple videos down the line, I'll be doing one on anti-arrhythmics, and will cover pharmacologic therapy for WPW.
Thanks!
Why do they always call it PR interval when it's really the PQ interval?
¯\_(ツ)_/¯
Dr. Eric mentioned this same question on his video on waves, segments and interval. FYI in russia, they call PQ interval.
I'm new to EP, how can you have a concealed WPW???? I thought a criteria for WPW was preexcitation with a manifest delta wave??? Am I missing something here???
"Concealed WPW" refers to the situation in which a patient has an accessory pathway that directly connects the atria and the ventricles, but which is only capable of retrograde conduction under normal circumstances. Therefore, there is no delta wave on resting ECG.
In contrast, the "WPW pattern" on ECG requires a delta wave by definition.
WPW syndrome = WPW pattern + symptoms related to tachyarrhythmias.
While a significant number of asymptomatic patients are incidentally found to have the WPW pattern on ECG, it's not known how many asymptomatic patients have a "concealed" WPW pathway since their ECGs in sinus rhythm look normal, and they would only have the accessory pathway identified during an EP study if they were symptomatic.
@@StrongMed Thanks for the reply. So when a WPW can only conduct retrogradely, why call it a WPW? I'm just really trying to understand the language and concepts accurately.
Thanks!!!!
How to differentiate pjrt and atrial ectopic tachy
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Rt
Thank you Dr Strong