Figure 4.

ECG/VCG with right‐sided anterior and inferior AP pre‐excitation. VCG of a 13‐year‐old boy with Ebstein's anomaly and right‐sided anterior and inferior AP. Note the “comets” of the initial part of the QRS are closer and erratic, indicating slow conduction on initial activation via AP (δ wave). In the horizontal plane, the QRS loop is directed backwards (right‐sided anterior and inferior AP). The electric axis shows upper displacement in the frontal plane. In the absence of WPW, the QRS axis is lower and the rotation is clockwise or in eight, except in some cases, which are counterclockwise (Ellison & Restieaux, 1972). S > R in V₁ indicates that the AP is on the right side and lower because the QRS complexes in II, III, and aVF are predominantly negative