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Abnormal Q Waves in Wolff-Parkinson-White Syndrome: Title and subTitle BreakIncidence and Clinical Significance FREE

Jeremy N. Ruskin, MD; Masood Akhtar, MD; Anthony N. Damato, MD; Andres R. Ticzon, MD; Sun H. Lau, MD; Antonio R. Caracta, MD
[+] Author Affiliations

Reprint requests to Cardiopulmonary Laboratory, US Public Health Service Hospital, Staten Island, NY 10304 (Dr Damato).


JAMA. 1976;235(25):2727-2730. doi:10.1001/jama.1976.03260510021018
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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 δ-defiections (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 reported by Wolff and White approximately 30 years ago. Erroneous diagnoses of MI can be virtually eliminated by normalizing the ORS complex by premature stimulation of the atrium during the effective refractory period of the accessory pathway.

(JAMA 235:2727-2730, 1976)

REFERENCES

Wolff L, White PD:  Syndrome of short PR interval with abnormal QRS complexes and paroxysmal tachycardia . Arch Intern Med 28:446-467, 1948;.
Wolff L, Richman JL:  The diagnosis of myocardial infarction in patients with anomalous atrioventricular excitation (Wolff-ParkinsonWhite Syndrome) . Am Heart J 45:545-570, 1953;.
Wolff L:  Diagnostic clues in the Wolff-Parkinson-White Syndrome . N Engl J Med 261:637-641, 1959;.
Eichert H:  Wolff-Parkinson-White Syndrome simulating myocardial infarction . Ann Intern Med 21:907-912, 1944;.
Spritz N, Cohen B, Frimter GW, et al:  Electrocardiographic interrelationship of the preexcitation (Wolff-Parkinson-White) syndrome and myocardial infarction . Am Heart J 56:715-721, 1958;.
Gallagher JJ, Gilbert M, Svenson R, et al:  Wolff-Parkinson-White Syndrome: The problem, evaluation and surgical correction . Circulation 51:767-785, 1975;.
Narula OS:  Wolff-Parkinson-White Syndrome . Circulation 47:872-887, 1973;.
Massumi RA, Zakauddin V, Mason DT:  Wolff-Parkinson-White Syndrome: A new look at an old problem . Mod Concepts Cardiovasc Dis 42:41-46, 1973;.
Boineau JP, Moore N, Spear JF, et al:  Basics of clinical ECG variations in right and left ventricular preexcitation: A unitary concept of WPW , in Driefus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973;, pp 421-455.
Wit AL, Weiss MB, Berkowitz WD, et al:  Patterns of atrioventricular conduction in the human heart . Circ Res 27:345-359, 1970;.

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Wolff L, White PD:  Syndrome of short PR interval with abnormal QRS complexes and paroxysmal tachycardia . Arch Intern Med 28:446-467, 1948;.
Wolff L, Richman JL:  The diagnosis of myocardial infarction in patients with anomalous atrioventricular excitation (Wolff-ParkinsonWhite Syndrome) . Am Heart J 45:545-570, 1953;.
Wolff L:  Diagnostic clues in the Wolff-Parkinson-White Syndrome . N Engl J Med 261:637-641, 1959;.
Eichert H:  Wolff-Parkinson-White Syndrome simulating myocardial infarction . Ann Intern Med 21:907-912, 1944;.
Spritz N, Cohen B, Frimter GW, et al:  Electrocardiographic interrelationship of the preexcitation (Wolff-Parkinson-White) syndrome and myocardial infarction . Am Heart J 56:715-721, 1958;.
Gallagher JJ, Gilbert M, Svenson R, et al:  Wolff-Parkinson-White Syndrome: The problem, evaluation and surgical correction . Circulation 51:767-785, 1975;.
Narula OS:  Wolff-Parkinson-White Syndrome . Circulation 47:872-887, 1973;.
Massumi RA, Zakauddin V, Mason DT:  Wolff-Parkinson-White Syndrome: A new look at an old problem . Mod Concepts Cardiovasc Dis 42:41-46, 1973;.
Boineau JP, Moore N, Spear JF, et al:  Basics of clinical ECG variations in right and left ventricular preexcitation: A unitary concept of WPW , in Driefus LS, Likoff W (eds): Cardiac Arrhythmias . New York, Grune & Stratton, 1973;, pp 421-455.
Wit AL, Weiss MB, Berkowitz WD, et al:  Patterns of atrioventricular conduction in the human heart . Circ Res 27:345-359, 1970;.
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