Dr Teffy Jose M-7 Unit Prof Dr Dhandapani’s Unit

ECG findingsHR- 72/minNormal sinus rhythm inverted P wave in lead 3 , P wave axis +20°PR interval - 0.24sQRS axis – RAD+QRS duration – 0.10sCrochetage sign + ( notch near apex of R

wave in lead 2,3, aVF)rsR’ in V1

Impression :

Atrial septal defect – ? sinus venosus type

Sinus venosus type of ASD

ECG features seen in addition to that of ostium secundum ASD are ( due to ectopic atrial pacemaker)

1.Left axis deviation of P wave 2.Inverted P wave in lead 2,3, avF 3.First degree AV block is more common

CROCHETAGE sign in ECGDescribed by Heller J et al in a study published

in JACC in march 1996Notch near the apex of R wave in ECG inferior

limb leads ( rapid up & down motion of the R wave tracing on its ascendant branch or near its zenith with an M shaped or a bifid pattern in most typical form &always involving initial 80 ms of QRS complex)

Seen in ASD – ostium secundum & sinus venosus type

Pathophysiological mechanism remains unknown

correlates with shunt severity ( increased incidence in larger anatomic defect & greater left to right shunt even in the presence of pulmonary hypertension)

high sensivity and specificity(≥92%) when it is present in all the three inferior limb leads

independant of the frequent incomplete right bundle branch block pattern seen in ASD

early disappearance of this pattern was observed in 35% of operated pts,although rt bundle branch block pattern persisted

association of these 2 patterns increase the sensitivity of ECG for the diagnosis of ASD

also reported in pts with patent foramen ovale & has been suggested as an ECG marker of a PFO associated with ischemic embolic stroke(paradoxical emboli)