ECG in Congenital Heart Disease

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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

AV canal defect

Patent ductus arteriosus

Pulmonary stenosis

Aortic coarctation

Ebstein’s anomaly

Surgically repaired TOF

Congenitally corrected TGA

Complete TGA/intra-atrial baffle

UVH with Fontan

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