Crochetage sign in atrial septal defect

Crochetage sign in atrial septal defect

Crochetage sign in atrial septal defect
Crochetage sign in atrial septal defect

Crochetage sign in atrial septal defect was described by Heller J et al in 1996 in study published in the Journal of American College of Cardiology [1]. It is a notch near the apex of the R wave in inferior leads. They noted a sensitivity of about 73% and specificity of 92% if the sign was present in all the three inferior leads. Early disappearance of the crochetage sign after surgical correction of atrial septal defect was found in 35% of cases even when the incomplete right bundle branch block (RBBB) pattern was persisting. The ECG illustrated above shows the notch at the apex of the R wave in leads II and aVF and a notch in the ascending limb of lead III.

This ECG also shows right atrial overload as evidenced by P wave amplitude of 0.3 mV in lead II. Incomplete RBBB pattern is seen as slurred S waves in lead I and rSrS pattern in V1.

Reference

  1. Heller J, Hagège AA, Besse B, Desnos M, Marie FN, Guerot C. “Crochetage” (notch) on R wave in inferior limb leads: a new independent electrocardiographic sign of atrial septal defect. J Am Coll Cardiol. 1996 Mar 15;27(4):877-82.

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