Crochetage in ASD

Report:

Sinus rhythm

Borderline left atrial abnormality

Borderline right axis deviation +90o

Incomplete right bundle branch block

Crochetage in inferior leads suggests ASD

Comment:

This one did have a fixed split of P2. She was, however, first diagnosed on this ECG.

Crochetage (just notching, but described by the French67) is said to be better than incomplete RBBB as marker of ASDs; if present in all three inferior leads, it has very high predictive power (and greater snob value). A transœsophageal echocardiogram (TOE, TEE in the USA) showed dilated right-sided chambers and pulmonary hypertension; there was a 2.8 cm defect in the atrial septum.

If you have any suggestions for or feedback on this report, please let us know.