ECG in Congenital Heart Disease

Secundum atrial septal defect

• Rhythm: normal sinus rhythm, increased risk of AF with age
• PR interval: first degree AV block in 6-19%
• QRS axis: 0° to 180°; RAD; LAD in Holt-Oram or LAHB
• QRS Configuration: rSr´ or rsR´ with RBBBi>RBBBc
• Atrial Enlargement: RAE 35%
• Ventricular hypertrophy: Uncommon
• Particularities: "Crochetage" pattern

Ventricular Septal Defect

• Rhythm: normal sinus rhythm, PVCs
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

AV canal defect

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Patent ductus arteriosus

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Pulmonary stenosis

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Aortic coarctation

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Ebstein’s anomaly

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Surgically repaired TOF

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Congenitally corrected TGA

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Complete TGA/intra-atrial baffle

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

UVH with Fontan

• Rhythm:
• PR interval:
• QRS axis:
• QRS Configuration:
• Atrial Enlargement:
• Ventricular hypertrophy:
• Particularities:

Dextrocardia

• Rhythm: NSR; P-wave axis 105° to 165° with situs inversus
• PR interval: Normal
• QRS axis: RAD
• QRS Configuration: Inverse depolarization and repolarization
• Atrial Enlargement: Not with situs inversus
• Ventricular hypertrophy: LVH: tall R V₁–V₂; RVH: deep Q, small R V₁ and tall R right lateral
• Particularities: Situs solitus: normal P-wave axis and severe CHD

ALCAPA

• Rhythm: NSR
• PR interval: Normal
• QRS axis: Possible LAD
• QRS Configuration: Ant-lat Q waves; possible ant-sept Q waves
• Atrial Enlargement: Possible LAE
• Ventricular hypertrophy: Selective hypertrophy of posterobasal LV
• Particularities: Possible ischemia