Dextrocardia & IVCD

Report:

Atrial fibrillation with ventricular response approx 112/min

Intraventricular conduction defect

QRS 0.15”

Lead misplacement or dextrocardia

Comment:

The patient had Poland’s syndrome51 with dextrocardia and a mild Ebstein’s anomaly; the former is frequent while the latter occurs in about 10% cases. Although the anomaly was morphologically mild (in terms of tricuspid valve displacement) there was a florid incompetence, with pulsatile liver.

The dextrocardia is by no means obvious, but becomes so when the chest leads are placed on the right side (Fig 69a below). The IVCD makes any further interpretation impossible.

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