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Crochetage, the Forgotten Electrocardiographic Sign

Carol Fernandez Hazim1, Mohammed Shaban2, Dessiree Cordero2

  • 1Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.

Cureus
|November 6, 2023
PubMed

Insights

A rare case of complete heart block in a teen was linked to a patent foramen ovale (PFO). PFO closure and a pacemaker resolved symptoms, highlighting the connection between these conditions.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Electrophysiology

Background:

  • Acquired complete heart block is a severe arrhythmia with diverse causes.
  • Atrial septal defect (ASD) is a common congenital defect; larger defects may cause symptoms.
  • The incidence of high-grade atrioventricular block in conjunction with ASD is not well-established.

Observation:

  • A 15-year-old male presented with acute dizziness and complete heart block on EKG, notable for a Crochetage sign.
  • Transthoracic and transesophageal echocardiograms confirmed a coexisting patent foramen ovale (PFO).

Findings:

  • The patient underwent successful patent foramen ovale (PFO) closure and permanent pacemaker implantation.
  • Following the interventions, complete resolution of symptoms and disappearance of the Crochetage sign were observed.

Implications:

  • This case underscores the potential association between patent foramen ovale and acquired complete heart block in adolescents.
  • Interventional closure of PFO combined with pacemaker insertion can effectively manage such complex cardiac conditions.
  • Further research is warranted to establish the precise incidence and underlying mechanisms of heart block in patients with PFO.

Keywords:
crochetage signpacemaker placementpatent foramen ovale closurepediatric cardiologythird-degree atrioventricular block

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