ELECTROCARDIOGRAPHIC AND VECTORCARDIOGRAPHIC DETECTION OF HEART DISEASE IN THE PRESENCE OF THE PRE-EXCITATION SYNDROME (WOLFF-PARKINSON-WHITE SYNDROME)

Abstract

Since the early phases of ventricular activation are altered in the pre-excitation syndrome (Wolff-Parkinson-White syndrome), the ecg diagnosis of myocardial disease in the presence of the pre-excitation syndrome may be difficult. For theoretic reasons previously discussed in connection with left bundle branch block (LBBB), the spatial vectorcardiogram (sVCG) may be useful in the diagnosis of myocardial disease in the presence of the Wolff-Parkinson-White syndrome. The sVCG was recorded in 15 patients with WPW syndrome using the equilateral tetrahedral reference system. Seven of the 15 patients were considered to be without heart disease on clinical grounds, whereas the remainder had various types of heart disease. In all but one of the patients without heart disease, the sVCG was not distorted except for the initial (delta) portion of the QRS sE-loop. In all of the patients with heart disease, the configuration of the QRS sE-loop beyond the delta portion was abnormal. These abnormal configurations were consistent in most instances with patterns previously described for the associated myocardial disease without the WPW syndrome. All but one patient with an abnormal ventricular gradient had clinical evidence of cardiac disease. The sVCG and ventricular gradient are therefore helpful in the diagnosis of myocardial disease in the presence of the pre-excitation syndrome.