Pre-excitation
Classification according to ICD-10 | |
---|---|
I45.6 | Pre-excitation syndrome |
ICD-10 online (WHO version 2019) |
In rhythmology, pre-excitation is a premature excitation of the ventricle via an antegrade-conducting , innate pathway that is parallel to the AV node . This pathway can cause cardiac arrhythmias , so-called AV reentry tachycardias (AVRT) .
The ECG often shows the typical sign of the delta wave, a hump-shaped, slowed down stroke, called the shoulder, at the beginning of the R wave with a shortened PQ time.
The first form discovered was the open Wolff-Parkinson-White syndrome (WPW syndrome). The diseases , also known as pre - excitation syndromes , are summarized under this generic term . It counts to this
- open WPW syndrome,
- hidden WPW syndrome,
- Permanent junctional reentry tachycardia (PJRT, Syn .: permanent junctional reciprocating tachycardia, permanent junctional reciprocal tachycardia / permanent junctional reverse tachycardia) and
- Lown-Ganong-Levine Syndrome (LGL Syndrome).
When tachycardia is running, a distinction is made between orthodromic and antidromic , depending on the direction of travel of the circular excitation . In orthodromic AVRT, the excitation runs from the atria to the ventricles via the physiological conduction system and the return from the ventricles to the atria via the accessory conduction pathway. Antidromic AVRT works in the opposite direction. In the case of antidromic AVRT, a return line is also possible via a further accessory conduction path with a complete recess in the excitation conduction system. The above description is independent of the position of the accessory pathway relative to the AV node.
Surname | management | AVRT | EKG at SR | ECG for tachycardia | comment |
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Open WPW Syndrome (Kent Bundle) |
antegrade (constant) and retrograde | orthodrome | PQ segment <120 ms Delta wave with widened QRS |
narrow QRS negative P-wave after QRS mostly in I. |
most common form. in a subset of short refractory period of the web may VHF are reconciled and VF lead |
antidromic (rare) |
Broad QRS complex | ||||
Open WPW Syndrome (Mahaim Fiber) |
antegrad (decremental = slow and retarding) | antidrom | sometimes small delta wave | maximum pre-excitation Negative P-waves mostly hidden by QRS |
no reliable differentiation from ventricular tachycardia |
Hidden WPW Syndrome |
retrograde | orthodrome | inconspicuous | narrow QRS no P-wave |
50% of WPW syndromes, no risk for VF |
Permanent junctional reentry tachycardia | retrograde, decremental | orthodrome | inconspicuous | narrow QRS P waves negative II, III, aVF, |
Tachycardia keeps coming back, often goes unnoticed, can lead to tachycardiomyopathy , often in children |
LGL Syndrome (James Bundle) |
antegrade | no | shortened PQ route without delta wave | no | without disease value |
Literature and Sources
- Gerd Herold : Internal Medicine . Cologne 2007, p. 254-256 .
- Mewis, Riessen, Spyridopoulos (Ed.): Cardiology compact - Everything for ward and specialist examination . 2nd Edition. Thieme, Stuttgart, New York 2006, ISBN 3-13-130742-0 , pp. 564-568 .
- R. Klinge: The electrocardiogram - guidelines for training and practice . 7th edition. Thieme, Cologne 1997, ISBN 3-13-554007-3 , p. 259-261 .
Individual evidence
- ↑ Becker's dictionary of abbreviations: PJRT. Retrieved April 15, 2009 .
- ↑ Angelika Lindinger, Thomas Paul (Hrsg.): EKG in children and adolescents: EKG basic information, cardiac arrhythmias, congenital heart defects in children, adolescents and adults . 7., completely revised. Thieme, Stuttgart 2015, ISBN 978-3-13-475807-8 , pp. 206-210 .