Chapter 16, Case 16: WPW Syndrome (Left Postero-Septal Accessory Pathway) Video Solutions, Clinical Cases in Cardiac Electrophysiology: Supraventricular Arrhythmias: Volume 1

Problem 1

Are there any clues on the 12-lead ECG in Fig. 16.2 suggesting a specific diagnosis?
A. No. This is a normal ECG.
B. Yes. Q waves in lead III, aVF suggesting remote inferior wall myocardial infarction.
C. Yes. Delta waves suggesting ventricular pre-excitation.
D. Yes. Negative T waves in I, aVL, suggesting LV lateral wall ischemia.
E. Yes. Incomplete RBBB suggesting arrhythmogenic cardiomyopathy.
(FIGURE CANT COPY).Figure 16.2 shows sinus rhythm with a heart rate of $75 \mathrm{bpm}, \mathrm{QRS}$ axis a $-15^{\circ}$, with overt ventricular pre-excitation, with positive delta waves in lead V1 to V6, lead I, aVL, negative in lead II, III and aVF. The diagnosis was therefore WPW syndrome.

Rehana Riaz

Numerade Educator

01:45

Problem 2

Where is the accessory pathway located?
A. Left lateral.
B. Left postero-septal.
C. Right postero-septal.
D. Right lateral.
E. Right antero-septal.

Jessica Wooten

Numerade Educator

Problem 3

Is this a good ablation site?
A. Yes. The bipolar EGM precedes the surface ECG by $15 \mathrm{~ms}$.
B. Yes. The unipolar EGM shows a "QS" aspect.
C. Yes. The local AV is short.
D. No. The surface ECG suggests a left postero-septal origin.
E. No. The local bipolar EGM is not the earliest local EGM that can be recorded in this patient.

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Problem 4

What is the next best step at this point of the procedure?
A. Increase power to $40 \mathrm{~W}$.
B. Increase $\mathrm{RF}$ application time to an ablation index of at least 550.
C. Map the CS venous system for a better ablation site.
D. Ameliorate the local contact by taking a deflectable sheath.
E. Map the left postero-septal region.

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Problem 5

(Fig. 16.8 CANT COPY).
Is this a better ablation site than the one in Fig. 16.8 ?
A. Yes. The bipolar EGM precedes the surface ECG by $25 \mathrm{~ms}$.
B. Yes. The unipolar EGM shows a "QS" aspect.
C. Yes. The local AV is short.
D. Yes. An accessory pathway potential can be seen at this site.
E. All of the above.

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