Pseudo-infarct patterns in the Wolff-Parkinson-White syndrome: importance of Q wave-T wave vector discordance.

Inferior lead pseudo-infarct Q waves are a common finding in the Wolff-Parkinson-White (WPW) syndrome. In a retrospective study of previously published cases of WPW, pseudo-infarct Q waves in the inferior leads were associated with positive or isoelectric T waves in 47 of 50 examples (94%). This characteristic Q wave-T wave vector discordance results from secondary repolarization changes due to altered ventricular activation. As a corollary, the presence of T wave inversion with inferior lead Q waves and a short PR interval is strongly suggestive, but not pathognomonic of inferior ischemia.