Pre-excitation

Classification according to ICD-10
I45.6	Pre-excitation syndrome
ICD-10 online (WHO version 2019)

ECG at the WPW. Delta waves (in C6) as the left shoulder of the QRS complex.

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.

Pre-excitation syndromes

Surname	management	AVRT	EKG at SR	ECG for tachycardia	comment
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

1. ↑ Becker's dictionary of abbreviations: PJRT. Retrieved April 15, 2009 . 
2. ↑ 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 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !