Scenario: This ECG was obtained from a 25-year-old Asian man following a cardiology referral for complaints of palpitations and a recent syncopal episode. The patient said he has had palpitations since he was a teenager. He stated the palpitations varied in duration from minutes to 1 hour, especially when he played sports. He found that he could sometimes stop the palpitations by “squatting down and taking a deep breath.” If the episodes were prolonged, he would feel very tired and dizzy.

This 12-lead ECG shows normal sinus rhythm and, along with the patient’s symptoms, represents classic signs and symptoms of Wolf-Parkinson-White (WPW) syndrome.

Also termed ventricular preexcitation syndrome, WPW is a congenital abnormality involving the presence of an extra or “accessory” electrical pathway between the atria and the ventricles. Impulses generated in the atria travel through this accessory pathway thus bypassing the normal...

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