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Patient
Young girl 11 years of age with Ebstein's disease and an accessory pathway; stable cardiovascular condition with some episodes of paroxysmal palpitations;
Trace
Sinus rhythm; pre-excitation pattern with very short PR interval, delta wave; left axis deviation of the QRS; Qs pattern in V1, QR in V2; probable right posteroseptal accessory pathway;
Exergue
Ebstein's disease is the congenital heart disease in which observation of an accessory pathway is the most common. Pre-excitation eliminates the typical pattern of right bundle branch block. The PR interval is generally longer than for a traditional accessory pathway and the QRS complex often shows very little pre-excitation.
Ebstein's disease is classically characterized by an abnormal development of the tricuspid valve, the septal leaf being displaced into the right ventricle.