ECG in Ebsteins anomaly

“Most of chd children dont look sick, but the scars on their chest are real .They are battle scars, the scars of their fight to live


Ecg is almost never normal in ebsteins anomaly of the heart.The range of anomalies include the following,The PQRST way

P wave -right atrial enlargement is almost always seen with rightward p wave axis.Such tall P waves are popular as ‘himalayan P’ waves.PR prolongation is also not uncommon(in about 50 %).

QRS-Axis may be normal or superior .rsR’ pattern with right bundle branch pattern is often seen.Deep Q waves may be seen in inferior leads(due to septal and RV fibrosis ).QRS amplitude is often low over RV leads.Pre excitation pattern of type B WPW seen in 20 % of cases and more than 1 pathway can coexist.Fragmented / splintered QRS is a normal shaped R wave followed by smaller,broader positive deflection.

Splintered QRS is a marker of greater disease severity, increased arrythmia risk and disappears post surgery

Arrythmias are common which includes AF,flutter, atrial or AV reentrant tachycardias, Mahaim fibre tachycardia and VT.Af can some times be very rapid and dangerous.

One easy clue for diagnosing ebstein is complete or incomplete RBBB with low QRS amplitude in right sided chest leads and first degree heart block.

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