Katz-Wachtel Phenomenon: TGA

Report:

Sinus rhythm 150/min (8 – 30 days: 115 – 190 normal rates)

Right atrial abnormality

Right ventricular hypertrophy

Positive T wave in V1

Probable biventricular hypertrophy

Katz-Wachtel phenomenon

Comment:

The infant had transposition of the great arteries (TGA), with a membranous VSD and patent foramen ovale.

The RAD and the dominant R wave in V1 are normal for a two-week old infant: it would be RVH in an adult. However, after the first 48 hours, upright T wave in V1 is a sign of RVH.

Large equiphasic mid-precordial RS complexes77 are associated with biventricular hypertrophy, classically in VSD patients. This infant survived through a large VSD and a patent foramen ovale; the latter was enlarged day after this ECG by a balloon atrial septostomy via the umbilical vein. Arterial switch operation was performed successfully a fortnight later.

Below (Fig 108a) is an example of neonatal (2 days) isolated RVH: RAA and RV1 > 10 mm. The upright T wave here may be normal, as is the RAD +160o. The baby’s pre-natal echo showed pericardial effusion, while Day 1 echo showed cardiomegaly but no effusion; there was a patent ductus arteriosus with bidirectional shunt. Perinatal asphyxia was suspected clinically.

Persistent large PDA would in time lead to biventricular hypertrophy