Right Axis Deviation in WPW Conduction
Report:
Sinus rhythm 88/min
Right axis deviation +110o
Wolff-Parkinson-White conduction, type ‘A’
Comment:
For ordinary clinical purposes WPW conduction is best divided into types ‘A’ and ‘B’, from Rosenbaum's now remote 1945 classification. Not only is it simple, it is easy to remember: in V1, ‘A’ is ‘above’ and ‘B’ is ‘below’ for the predominant QRS deflection. Type ‘A’ has the bypass bundle of Kent inserting into the left ventricle, type ‘B’ into the right.
Here, like in the previous Case 220 there is an illusion of normal PR interval. In V6, again, there appears to be a normal PR segment – but the simultaneous V4 and V5 show that δ wave starts from the end of the P wave.
The RAD here has no clinical significance, but can be, along with the dominant R in V1, mistaken for a sign of RVH.
Another example of RAD due to WPW conduction is shown below (Fig 21a).
The conduction becomes syndrome when there are attributable tachyarrhythmias, most commonly SVT, most dangerously AF.
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