accessory pathways

Will there always be a Delta wave if a patient has an accessory pathway?

No. If the duration of excitation via the AV node is shorter than the conduction time via the accessory pathway, the delta wave is completely missing. In the case of pathways on the left-lateral wall of the heart, excitation from the sinus node to the pathway must travel a greater distance to the accessory pathway than to the AV node.

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