Abnormal Q waves in Wolff-Parkinson-White syndrome. Incidence and clinical significance
J. N. Ruskin, M. Akhtar, A. N. Damato, A. R. Ticzon, S. H. Lau and A. R. Caracta
Between January 1970 and January 1975 the diagnosis of
Wolff-Parkinson-White syndrome was entertained in 44 patients. Thirty-one
(70%) of these patients had negative sigma-deflections (Q waves) on one or
more electrocardiographic leads, thereby simulating a pattern of myocardial
infarction (Mi). Fifteen patients (34%) were initially referred with an
erroneous diagnosis of Mi based on the presence of Q waves. In nine of
these 15 patients, the referring diagnosis was Mi plus ventricular
preexcitation; in six, the diagnosis of ventricular preexcitation was
overlooked entirely. The incidence of misdiagnosis (34%) was exactly the
same as that reportly by Wolff and White approximately 30 years ago.
Erroneous diagnosis of Mi can be virtually eliminated by normalizing the
QRS complex by premature stimulation of the atrium during the effective
refractory period of the accessory pathway.
