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A female teenager presented with palpitations.
The baseline rhythm on her ECG demonstrates sinus rhythm with normal PR interval of 120 ms, a mild degree of delta wave, RSR′ morphology in V1 with a precordial transition zone between V1 and V2. The frontal axis demonstrates normal QRS axis, in particular a positive lead III and aVF vectors, and negative aVR and aVL vectors, suggesting an overall inferior propagating QRS vector.
Intermittently, however, she exhibits a different QRS morphology and a different ventricular activation vector (lead III and aVL), annotated with black arrows in figure 1.
Contributors CLC contributed to the conception of idea, write-up, review and finalisation of the manuscript. ON contributed to the review and edits of the manuscript. HSL contributed to the conception of idea, review and edits of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.