ECG Interpretation - Gaurav Kumar, 19-year-old Male

• Date: 26-05-2026, time 11:37:38 AM
• Speed: 25 mm/s | Gain: 10 mm/mV
• Filters: 0.67-25 Hz, AC50

Measured Intervals

Machine Diagnosis (confirmed on printout)

Systematic Interpretation

1. Rate

2. Rhythm

3. Intervals - Points to Note

• PR interval: 84 ms - This is notably SHORT (normal ≥120 ms). A short PR can suggest:
  • Pre-excitation (e.g., Wolff-Parkinson-White syndrome or LGL syndrome) - look for a delta wave at the onset of QRS
  • Enhanced AV nodal conduction
  • This warrants careful review of the QRS for delta waves
• QRS: 137 ms - This is mildly PROLONGED (normal <120 ms), which combined with a short PR could suggest pre-excitation (delta wave + short PR + wide QRS = classic WPW pattern). Alternatively, this could represent an incomplete or complete bundle branch block.
• QTc: 445 ms - Borderline prolonged (upper limit for males is typically 440-450 ms). This needs clinical context but is at the upper edge of normal.

4. Axis

• P axis: 59° - Normal (0-90°), confirming sinus origin
• QRS axis: 26° - Normal
• T axis: 45° - Normal

5. Key Concern: Short PR + Wide QRS

• A delta wave (slurred upstroke at the start of the QRS)
• Secondary ST/T wave changes

Summary

Clinical Recommendation

1. Examine the ECG tracing carefully for delta waves - if present, referral to a cardiologist for electrophysiology evaluation is indicated.
2. Echocardiogram to rule out structural heart disease.
3. If WPW is confirmed, risk stratification (exercise testing, Holter monitor, possibly EP study) is standard practice before clearing a young patient for vigorous activity.
4. The bradycardia and sinus arrhythmia alone in a 19-year-old do not require treatment.

Disclaimer: This interpretation is for educational purposes. Clinical decisions must be made by a qualified physician who can examine the patient and review the full ECG tracing in detail.

Wolff-Parkinson-White (WPW) Syndrome in a Young Patient

What Is WPW?

Why WPW in a Young Patient Is Especially Significant

"Sudden death risk is low but front-loaded in the young. Asymptomatic children must be treated differently than adults. An aggressive approach to asymptomatic WPW is warranted in this era of highly successful, low-risk catheter ablations."

• Atrial fibrillation develops → rapid conduction over the accessory pathway (which has no rate-limiting properties like the AV node) → ventricular fibrillation → sudden death

• Orthodromic AVRT (most common, ~80%): antegrade via AV node, retrograde via accessory pathway → narrow complex SVT
• Antidromic AVRT / AF with rapid conduction (dangerous): antegrade via accessory pathway → wide complex, can degenerate to VF

Drugs to AVOID in WPW

• Tintinalli's Emergency Medicine, p. 881

Management Pathway for This 19-Year-Old

WPW pattern on ECG (short PR + wide QRS ± delta wave)
          |
    Is patient SYMPTOMATIC?
    (palpitations, syncope, tachycardia episodes)
          |
     YES → Urgent cardiology referral + EPS
     NO (asymptomatic) →
          |
     Exercise stress test
     → Abrupt loss of delta wave at high HR = lower risk
     → Delta wave persists at high HR = higher risk → EPS
          |
     Electrophysiology Study (EPS)
     → Confirms accessory pathway
     → Measures refractory period
     → Guides ablation decision
          |
     Radiofrequency Catheter Ablation
     → >95% success rate
     → Low complication risk
     → Curative in most cases

Bottom Line for Gaurav (19M)

1. The ECG pattern is highly suspicious for WPW - short PR (84 ms) + wide QRS (137 ms) is the classic combination. Physical inspection of the tracing for delta waves is the next step.
2. Asymptomatic does not mean safe - in a 19-year-old, cardiology referral and EPS is the current standard approach.
3. Echocardiogram to rule out associated structural disease (e.g., Ebstein's anomaly, which has a 25% association with WPW involving right-sided accessory pathways).
4. Do not start any AV-nodal blockers until WPW is excluded or properly evaluated.
5. Catheter ablation is low-risk, highly effective, and effectively curative - the preferred definitive treatment in young patients.

Disclaimer: This is educational content. Clinical decisions must be made by a qualified cardiologist/electrophysiologist who can review the full ECG and examine the patient.