Scalar, Vector, and Intracardiac Electrocardiograms in Ebstein's Anomaly

The Diagnosis of Ebstein's Disease of the Heart

“…Though no attacks of tachycardia were recorded in our patients, six of them complained of palpitations, and arrhythmias were provoked in four patients during cardiac catheterization. One patient had Wolff-Parkinson-White block, which is present in 5-10% of cases with Ebstein's disease, and the disease should especially be suspected when the block is of type B (8). The PR (PQ) interval was prolonged in most children in our series.…”

Mild Ebstein's anomaly.

“…The electrocardiograms of our patients were characteristic of Ebstein's anomaly, in which right bundle-branch block pattern is common and the QRS complexes are usually slurred and of low voltage (Van Lingen and Bauersfeld, 1955;Blount et al, 1957;Schiebler et al, 1959;Genton and Blount, 1967;Lowe et al, 1968). The exact cause of the electrocardiographic appearances is disputed; Kezdi and Wennemark (1958) postulated an abnormal conduction pathway, whereas other workers (Van Lingen and Bauersfeld, 1955;Blount et al, 1957) thought that the large, thin-walled atrialized portion of the right ventricle was responsible for the wide, low voltage QRS complex.…”

Intracardiac electrocardiogram in endomyocardial fibrosis.

“…11 shows an example of this "atrialization" of the right ventricle, where the intracardiac electrocardiogram gives the only indication that the identical pressure pulses are from two different cavities. There is an analogy here with Ebstein's anomaly of the tricuspid valve, where the intracardiac electrocardiogram can localize the catheter tip in the true atrium or in the atrialized part of the right ventricle (Lowe et al, 1968). When there is atrial fibrillation or atrial flutter the transition in the curves as the catheter tip crosses the tricuspid valve is strikingly marked by the abrupt appearance of fibrillation or flutter waves.…”