15-year old patient presenting with rapid palpitations and dizziness. Symptoms resolved en route to hospital. Describe the ECG.

Describe and interpret this ECG


Main Abnormalities

This ECG is diagnostic of the Wolff-Parkinson-White (WPW) syndrome:

Other Features:

  • Dominant S wave in V1 — this “type B” pattern indicates a right-sided accessory pathway
  • Tall R waves and inverted T waves mimic the appearance of LVH — this is an electrical phenomenon due to WPW and not a sign of ventricular hypertrophy
  • ST segments and T waves show typical “discordant” changes — they point in in the opposite direction to the QRS complex, similar to LBBB

TOP 100 ECG Series

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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