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©2013 UpToDate ® Print Email 12-lead electrocardiogram (ECG) of a right posteroseptal accessory AV pathway Electrocardiogram in sinus rhythm from a patient with Wolff-Parkinson-White syndrome shows a maximally preexcited QRS complex. There is early transition across the precordial leads, with R/S ratio of 1 occurring in lead V2. The delta waves are positive in the lateral leads I, aVL, and V6, and negative in leads III and aVF, localizing the pathway to the posteroseptal area. The positive delta wave in lead II and in the lateral leads localize the pathway to the right side.

©2013 UpToDate ® Print Email 12-lead electrocardiogram (ECG) of a right posteroseptal accessory AV pathway Electrocardiogram in sinus rhythm from a patient with Wolff-Parkinson-White syndrome shows a maximally preexcited QRS complex. There is early transition across the precordial leads, with R/S ratio of 1 occurring in lead V2. The delta waves are positive in the lateral leads I, aVL, and V6, and negative in leads III and aVF, localizing the pathway to the posteroseptal area. The positive delta wave in lead II and in the lateral leads localize the pathway to the right side. 12-lead electrocardiogram (ECG) of a right posteroseptal accessory AV pathway Electrocardiogram during rapid atrial pacing from a patient with Wolff-Parkinson-White syndrome. The QRS complex is maximally excited; the PR interval is short, and there is a left bundle branch morphology, left axis deviation, and early transition across the anterior precordial leads. The delta waves are positive in the lateral leads I, aVL, and V6 and negative in the inferior leads, localizing the pathway to the posteroseptal region. The negative delta wave in lead II places the pathway on the right, in the area between the coronary sinus os and middle cardiac vein. 12-lead electrocardiogram (ECG) of a right posteroseptal accessory AV pathway The 12 lead ECG during rapid atrial pacing shows QRS complexes that are maximally preexcited; the complexes have a pattern suggesting an AV accessory pathway located in the right posteroseptal area. At the time of ablation, the pathway was localized to the midseptal region. 12-lead electrocardiogram (ECG) of a left posteroseptal accessory AV pathway Electrocardiogram during right atrial pacing in a patient with Wolff-Parkinson-White syndrome shows a long stimulus to the P wave with a short PR interval, the appearance of both right and left bundle branch block morphologies, and a negative QRS morphology and delta wave in the inferior leads. This localizes the pathway to the posteroseptal area. The presence of a positive delta wave in lead I, RS ratio in lead V1 of approximately 1, and a negative delta wave in lead II places the pathway on the left side, inside the coronary sinus os or allong the middle cardiac vein. This type of accessory pathway may be related to cardiac venous anomalies and aneurysms.