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Kent's Bundle Localization in WPW

Criteria (Algorithm) of localization of the bundle of Kent (WPW syndrome)

WPW Syndrome

WPW pre-excitation syndrome, accessory pathway, bundle of Kent
  • In WPW syndrome, an accessory pathway (Kent bundle) is present
  • Kent Bundle
    • Affects about 0.5% of the population (the most common accessory pathway)
    • Connects atria and ventricles (Atrio-Ventricular bypass)
    • Activates (pre-excites) one ventricle earlier than the AV junction
    • Produces a Delta wave on the ECG

  • Delta Wave

ECG and WPW Syndrome

ECG WPW syndrome pattern, delta wave, short PR interval, broad QRS complex

Localization of Kent Bundle

WPW syndrome, Accessory pathway 8 anatomic locations
  • Kent bundle most commonly occurs:
    • Left atrium: 46-60%
    • Right atrium: 13-21%
    • Postero-septal: 25%
    • Anteo-septal: 2%

  • For localizing the Kent bundle to the left and right atrium:
    • Leads V1 and V6 are used
    • WPW syndrome type A (left atrium)
      • Kent bundle connects the left atrium to the left ventricle
    • WPW syndrome type B (right atrium)
      • Kent bundle connects the right atrium to the right ventricle

WPW Syndrome Type A (Left Atrium)

WPW syndrome Type A, left-sided accessory pathway

WPW Syndrome Type B (Right Atrium)

WPW syndrome Type B, right-sided accessory pathway
  • Kent bundle connects the right atrium + right ventricle
  • Impulse pre-excites the right ventricle, then spreads to the entire myocardium
  • QRS resembles Left Tawar Bundle Branch Block
  • QRS complex is negative in V1

d’Avila Algorithm


  • LL: Left Lateral
  • LP: Left Posterior
  • LPS: Left Postero-Septal
  • PS: Postero-Septal
  • RPS: Right Postero-Septal
  • RL: Right-Lateral
  • AS: Antero-Septal
  • MS: Mid-Septal

  • Tr: Tricuspid Valve
  • Pu: Pulmonary Valve
  • Ao: Aortic Valve
  • Mi: Mitral Valve
Heart atria anatomy, Criteria (Algorithm) of localization of the bundle of Kent (WPW syndrome)

d Avila algorithm, WPW syndrome accessory pathways anatomic locations


WPW syndrome left lateral accessory pathway anatomic location
ECG WPW syndrome, left lateral accessory pathway

WPW Syndrome



WPW syndrome left lateral accessory pathway anatomic location
ECG WPW syndrome, left lateral accessory pathway anatomic location

WPW Syndrome

  • WPW Syndrome
  • Kent's bundle is left lateral
    • V1: Positive QRS
    • III: Positive QRS


WPW syndrome right postero-septal accessory pathway anatomic location
ECG wpw syndrome right postero septal accessory pathway anatomic location

WPW Syndrome



WPW syndrome left lateral accessory pathway anatomic location
ECG wpw syndrome, left lateral accessory pathway (bundle of Kent)

WPW Syndrome



WPW syndrome right lateral or postero septal accessory pathway anatomic location
ECG wpw syndrome accesory pathway: fight lateral, or postero septal

WPW Syndrome




Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Home /

Kent's Bundle Localization in WPW

Criteria (Algorithm) of localization of the bundle of Kent (WPW syndrome)

WPW Syndrome

  • In WPW syndrome, an accessory pathway (Kent bundle) is present
  • Kent Bundle
    • Affects about 0.5% of the population (the most common accessory pathway)
    • Connects atria and ventricles (Atrio-Ventricular bypass)
    • Activates (pre-excites) one ventricle earlier than the AV junction
    • Produces a Delta wave on the ECG

  • Delta Wave
WPW pre-excitation syndrome, accessory pathway, bundle of Kent

ECG and WPW Syndrome
ECG WPW syndrome pattern, delta wave, short PR interval, broad QRS complex

Localization of Kent Bundle

  • Kent bundle most commonly occurs:
    • Left atrium: 46-60%
    • Right atrium: 13-21%
    • Postero-septal: 25%
    • Anteo-septal: 2%

  • For localizing the Kent bundle to the left and right atrium:
    • Leads V1 and V6 are used
    • WPW syndrome type A (left atrium)
      • Kent bundle connects the left atrium to the left ventricle
    • WPW syndrome type B (right atrium)
      • Kent bundle connects the right atrium to the right ventricle

WPW syndrome, Accessory pathway 8 anatomic locations

WPW Syndrome Type A (Left Atrium)

WPW syndrome Type A, left-sided accessory pathway
  • Kent bundle connects the left atrium + left ventricle
  • Impulse pre-excites the left ventricle, then spreads to the entire myocardium
  • QRS resembles Right Tawar Bundle Branch Block
  • QRS complex is positive in V1

WPW Syndrome Type B (Right Atrium)

WPW syndrome Type B, right-sided accessory pathway
  • Kent bundle connects the right atrium + right ventricle
  • Impulse pre-excites the right ventricle, then spreads to the entire myocardium
  • QRS resembles Left Tawar Bundle Branch Block
  • QRS complex is negative in V1

d’Avila Algorithm



Heart atria anatomy, Criteria (Algorithm) of localization of the bundle of Kent (WPW syndrome)
  • LL: Left Lateral
  • LP: Left Posterior
  • LPS: Left Postero-Septal
  • PS: Postero-Septal
  • RPS: Right Postero-Septal
  • RL: Right-Lateral
  • AS: Antero-Septal
  • MS: Mid-Septal
  • Tr: Tricuspid Valve
  • Pu: Pulmonary Valve
  • Ao: Aortic Valve
  • Mi: Mitral Valve


d Avila algorithm, WPW syndrome accessory pathways anatomic locations


ECG WPW syndrome, left lateral accessory pathway

WPW Syndrome

  • Shortened PQ interval < 0.12s
  • Delta wave and wide QRS approximately 0.18s
    • The QRS complex in WPW syndrome resembles the Greek letter delta
  • Kent's bundle is left lateral
    • V1: Positive QRS
    • III: Positive QRS
 WPW syndrome left lateral accessory pathway anatomic location


ECG WPW syndrome, left lateral accessory pathway anatomic location

WPW Syndrome

  • WPW Syndrome
  • Kent's bundle is left lateral
    • V1: Positive QRS
    • III: Positive QRS
 WPW syndrome left lateral accessory pathway anatomic location


ECG wpw syndrome right postero septal accessory pathway anatomic location

WPW Syndrome

  • Kent's bundle is right postero-septal
    • V1: Negative QRS
    • III: Negative QRS
      • No QRS configuration
    • II: Positive QRS
    • V2: Positive QRS
 WPW syndrome right postero-septal accessory pathway anatomic location


ECG wpw syndrome, left lateral accessory pathway (bundle of Kent)

WPW Syndrome

 WPW syndrome left lateral accessory pathway anatomic location


ECG wpw syndrome accesory pathway: fight lateral, or postero septal

WPW Syndrome

  • Kent's bundle is
    • Right Lateral
    • or Postero-Septal
  • V1: Negative QRS
  • III: Negative QRS
  • No QRS configuration
    • II: Negative QRS
    • V2: Biphasic
    • It cannot be precisely determined if it is positive or negative
    • Kent's bundle is located somewhere
      • Right Lateral
      • Postero-Septal
  • Pathological Q in inferior leads (II, III, aVF)
 WPW syndrome right lateral or postero septal accessory pathway anatomic location



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers