SUMMARY NOTES IN THE RECORD s20541 (Duration: 22:59:00.000) Starting time, recording date: 12:13:00 27/09/1999 Lead 0: V4 Lead 1: MLIII Age: 23 Sex: F Comments: This unusual record demonstrates intermittent pre-excitation that results in considerable variability of the ST segment. During pre-excitation there is a depression in the ST segment. When alteration in the conduction pattern is rapid, the average ST segment as displayed by SEMIA shows minimal sustained change. When conduction shifts and remains consistent for minutes, then the ST segment changes significantly. To make matters more complicated, the degree of pre-excitation often varies, producing intermediate QRS and ST morphological forms. This record shows some rate-related episodes. Symptoms during Holter recording: No data Diagnoses: Wolf-Parkinson-White (WPW) syndrome Treatment: Medications: No Balloon Angioplasty: No data Coronary Artery bypass Grafting: No data History: Palpitations Hypertension: No Left ventricular hypertrophy: No Cardiomyopathy: No Valve disease: No Electrolyte abnormalities: No Hypercapnia, anemia, hypotension, hyperventilation: No Atrioventricular nodal conduction delay: No Intraventricular conduction block: No, but intermittent pre-excitation Previous Myocardial Infarction: No Previous tests: ECG stress test: No Thallium/Stress echo: No data Left ventricular function: Normal Echocardiogram: No data Coronary Arteriography: No Baseline ECG: WPW (short PR interval and delta wave) Holter Recording: Date: 27/09/1999 Recorder: Remco ST ANNOTATIONS A. Criteria of 30 seconds and 75 microVolts (s20541.sta) Lead 0: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 11 Duration: 1:27:40 6.36% Axis shifts: 0 Conduction-change shifts: 281 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 5 Duration: 47:02 3.41% Axis shifts: 0 Conduction-change shifts: 148 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 16 Duration: 2:14:42 4.88% Axis shifts: 0 Conduction-change shifts: 429 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 11 Duration: 1:28:26 6.41% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 11 Duration: 1:28:26 6.41% Unreadable intervals: 0 Duration: 0:00 0.00% B. Criteria of 30 seconds and 100 microVolts (s20541.stb) Lead 0: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 9 Duration: 1:15:00 5.44% Axis shifts: 0 Conduction-change shifts: 281 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 4 Duration: 40:50 2.96% Axis shifts: 0 Conduction-change shifts: 148 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 13 Duration: 1:55:50 4.20% Axis shifts: 0 Conduction-change shifts: 429 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 9 Duration: 1:15:40 5.49% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 9 Duration: 1:15:40 5.49% Unreadable intervals: 0 Duration: 0:00 0.00% C. Criteria of 60 seconds and 100 microVolts (s20541.stc) Lead 0: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 6 Duration: 1:06:22 4.81% Axis shifts: 0 Conduction-change shifts: 281 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Lead 1: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 3 Duration: 23:04 1.67% Axis shifts: 0 Conduction-change shifts: 148 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Total: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 9 Duration: 1:29:26 3.24% Axis shifts: 0 Conduction-change shifts: 429 Noisy events: 0 Unreadable intervals: 0 Duration: 0:00 0.00% Combined: Ischemic episodes: 0 Duration: 0:00 0.00% Rate-related episodes: 6 Duration: 1:07:02 4.86% Unreadable intervals: 0 Duration: 0:00 0.00% Combined [ischemic or rate-related]: ST segment episodes: 6 Duration: 1:07:02 4.86% Unreadable intervals: 0 Duration: 0:00 0.00% QRS ATRUTH ANNOTATIONS (s20541.atr) Total number of beats 115151 Normal beats 114577 Aberrated atrial premature beats 1 Premature ventricular contractions 563 Fusions of ventricular and normal beat 5 Supraventricular premature or ectopic beats 4 Paced beats 1