All was confirmed by positive QRS complex seen in

bloods mentioned above result were within normal limits which suggests Jane was
in a good general condition. There is no specific laboratory test needed to
confirm the diagnosis of WPW, however it is essential to perform routine blood
test to diagnose any abnormalities in general health. Moreover, it is
reasonable to include urea and electrolytes in blood test as any irregularities
in these tests could contribute to dysrhythmia or any other abnormalities
within the organs (reference

12 – lead Electrocardiogram (ECG) is one of the most popular and commonly used
to help and diagnosis clinical investigations in current medicine (Gray and Houghton 2014).
It is particularly useful in diagnosis cardiac investigation, abnormalities
within the heart and other disorders which affects the human body (Gray and Houghton 2014). A
12- lead ECG is of the most effective tools to diagnose Wolf Parkinson’s’ White
Syndrome (WPW).

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Detailed Systematic Approach to 12 Lead ECG:

and rhythm was assessed when obtaining the ECG (appendix A). Sinus Rhythm of 75
beats per minute suggests normal regular heart beat with P waves present before
each QRS complex. When assessing rate and rhythm in patients with WPW, it is
important to identify any irregularities within the rate and rhythm. There is
high chance of patient developing paroxysmal atrial fibrillation (AF) which is
an abnormally rapid and irregular heart rhythm within the atrium, in a
combination with WPW it can predispose patients to life threatening rhythm such
a ventricular fibrillation (reference
2018). Although the development of AF in relatively unknown, it is
essential for healthcare professional to identify and medically treat the
patient efficiently (Centurion,
Shimizu, Isomoto and Konoe 2008).

Axis is the direction of electrical activity of the heart (Gray and Houghton
2012). According to Jane’s ECG, Left Axis Deviation of something degree was calculated. This was
confirmed by positive QRS complex seen in lead I and negative QRS in lead II,
III and avF (LITFL 2019).
Furthermore reference 2017 states patients present with type A pattern of WPW
are likely to present with Left Axis Deviation due to the association of right
sided accessory pathway.

a normal ECG, the P wave represents atrial depolarisation, this is where the SA
node fires and the electrical impulses spreads across the atria, thus representing
atrial contraction (Jevon
2013). Normal P waves are present in Janes ECG (Appendix A), which
present atrial activity. The P-R interval is measure form the beginning of
atrial depolarisation (P wave) and onset of ventricle depolarisation (QRS
Complex) (reference 2017).
A normal individual will have a P-R interval to 0.12 – 0.20 seconds. As seen
appendix A, Jane present with a shortened P-R interval of 0.08 seconds, this is
because the additional accessory pathway which connect the atria and ventricles
impulses fast that normal therefore does not delay the signal as it would do in
a normal ECG where a short delay is seen just before the impulse travels to the
purkinje fibres and to the ventricles (reference 2017).

QRS complex presents ventricular depolarisation. Normal QRS interval is 0.12
seconds, when analysing QRS complex in appendix A, noticed a broad complex QRS
with the present of’ upstroke R waves also known as “delta” waves seen in chest
leads V2 to V6 suggesting WPW syndrome. Delta waves are caused by accessory
pathways conduction to the ventricles, because they travel around the AV node
to the pre- exciting pathway, this means the impulses takes longer to contract
ventricles resulting in slurred delta wave with widened QRS complex (reference 2017). Sometime
due to the broad QRS complex, as seen in V2 it can be easily misinterpreted as
a bundle branch block (Lewis
2018), so it is essential for healthcare professionals to diagnose and
interpret ECG correctly.

interval is the time taken for ventricular depolarisation to ventricular repolarisation
and represent the recovery of ventricular myocardium (reference 2017). Normal Q-T Interval is between
0.33 seconds to 0.44 seconds (reference 2017). When examining Jane’s ECG (appendix A) a normal
QT interval in 0.40 seconds is present, this suggest normal activity between
ventricular depolarisation to repolarisation, no abnormities where found in
this part of the conduction system.

leads was the examined to look for any abnormalities. T wave inversion was
noted in V2 and V3. Patients with WPW sometime present with ST- segment with T
wave inversion, this is due to pre- excitation or arrhythmias related with WPW
(reference 2017).

waves were found in limb leads I, III, aVL indicating pre- excitation of the ventricles,
furthermore, delta waves can sometimes be negative this depends on the location
of accessory pathway as seen in appendix A inferior leads III and avF are
negative, however, a cautious approach must be taken as negative delta waves
can be mistake with Q waves which could indicate the diagnosis of an inferior
myocardial infarction (Gray
and Houghton 2014).

electrophysiologist is a cardiologist who specialises in diagnosis and treating
electrical system of the heart and heart rhythm disorders (reference) Jane was
referred to electrophysiologists for further review and treatment of WPW, it
was highlighted by the cardiologists that some drugs should be avoided for
patient with WPW, this included adenosine and calcium channel blockers and can
be potentially lethal (reference
2018). Drugs such as verapamil, digoxin or adenosine can delay the onset
of action, block the AV node which can trigger ventricular fibrillation (reference 2017).

Current Cardioversion (DCCV) can be useful in the treatment of WPW,
particularly if the patient is presenting with atrial fibrillation and
haemodynamically unstable (reference
2018), however Jane presented with type pattern of WPW with sinus
rhythm, no episode of arrhythmia was noted and remained stable whilst hospital

treatment of WPW are available within the medical setting, with radio-
frequency catheter ablation of the accessory pathway being the first line of
treatment nowadays (reference
2011), Prior to proceeding to ablation, electrophysiology (EP) studies
is usually preferred to study the hearts electrical conduction system in detail
and the proceed to ablation. It’s an invasive procedure to diagnose and
potentially treat the disorder of the hearts electrical system (Hatchett and Thompson 2011).
It is generally a safe procedure that can pinpoint the location of the heart
rhythm problems. Radio- frequency catheter ablation procedure was used to
locate patients heart rhythm, outcome of the ablation showed Jane had septal
accessory pathway ablation with partial success. According to Mecedo et al 2012, septal
accessory pathway particularly difficult to treat and ablate as opposed to
other location, hence the outcome of partial success, because off this, it is
essential to clinically understand the anatomy and development of the heart for
a successful ablation (Mecedo
et al 2012).