Document Detail


"Crochetage" (notch) on R wave in inferior limb leads: a new independent electrocardiographic sign of atrial septal defect.
MedLine Citation:
PMID:  8613618     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: This study sought to determine the clinical significance of a "crochetage" pattern--a notch near the apex of the R wave in electrocardiographic (ECG) inferior limb leads--in secundum atrial septal defect. BACKGROUND: Atrial septal defect is often overdiagnosed on the basis of classical clinical features. Thus, more specific signs on the ECG for screening are needed. Methods. We searched for a crochetage pattern in 1,560 older children and adults: 532 with secundum atrial septal defect, 266 with ventricular septal defect, 146 with pulmonary stenosis, 110 with mitral stenosis, 47 with cor pulmonale and 459 normal subjects. RESULTS: This pattern was observed respectively in 73.1%, 35.7%, 23.3%, 6.4%, 10.6% and 7.4% of these groups (p<0.001). In atrial septal defect, its incidence increased with larger anatomic defect (p<0.0001) or greater left-to-right shunt (p<0.0001), even in the presence of pulmonary hypertension. By multiple regression analysis, only shunt size (p<0.0006) and defect location (p<0.0001) were the determinants of its presence. In all groups, the specificity of this sign for the diagnosis was remarkably high when present in all three inferior limb leads (> or = to 92%), even when comparison was limited to patients with an incomplete right bundle branch block (> or = 95.2%). Early disappearance of this pattern was observed in 35.1% of the operated-on patients although the right bundle branch block pattern persisted. CONCLUSIONS: A crochetage pattern of the R wave in inferior limb leads is frequent in patients with atrial septal defect, correlates with shunt severity and is independent of the right bundle branch block pattern. Sensitivity and specificity of this sign are remarkably high when it is associated with an incomplete right bundle branch block or present in all inferior limb leads.
Authors:
J Heller; A A Hag?ge; B Besse; M Desnos; F N Marie; C Guerot
Related Documents :
2365528 - Cross-sectional echocardiography in the diagnosis of atrioventricular septal defect.
17590718 - Pattern of congenital heart disease in king fahd specialist hospital, buraidah.
17433988 - Atrioventricular canal: modified single patch technique.
19804548 - Septal dyskinesia and global left ventricular dysfunction in pediatric wolff-parkinson-...
25298468 - 60greater mechanical dyssynchrony is demonstrated by cardiac magnetic resonance cine im...
8237518 - Ischemic cardiopathy and other heart diseases: differences in carotid atheromas examine...
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  27     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1996 Mar 
Date Detail:
Created Date:  1996-06-03     Completed Date:  1996-06-03     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  877-82     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Department, Boucicaut Hospital, Necker-Enfants Malades, Faculty of Medicine, Paris, France.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Bundle-Branch Block / diagnosis
Child
Child, Preschool
Cohort Studies
Electrocardiography*
Electrodes
Extremities
Female
Heart Septal Defects, Atrial / diagnosis*
Humans
Male
Middle Aged
Predictive Value of Tests
Regression Analysis
Retrospective Studies
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Radiofrequency catheter ablation of right ventricular outflow tachycardia in children and adolescent...
Next Document:  Doppler echocardiography reliably predicts pulmonary artery wedge pressure in patients with chronic ...