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When Ebstein Meets Fallot: A Right-Sided ECG Puzzle
Jules Ader1, Charlène Bredy1, Jean-Luc Pasquié1
1Département de Cardiologie Hôpital Arnaud de Villeneuve, CHU Montpellier, Montpellier, France.
Case Summary:
A 14-year-old boy was admitted after resuscitated ventricular fibrillation. He had tetralogy of Fallot associated with Ebstein's anomaly, surgically repaired at age 7 without tricuspid intervention. His ECG demonstrates overlapping features of both conditions: high-amplitude right bundle branch block and right ventricular hypertrophy consistent with repaired tetralogy of Fallot, along with broad "Himalayan" P waves, first-degree atrioventricular block, and fragmented QRS complexes reflecting Ebstein-related conduction abnormalities. This electrocardiographic coexistence illustrates how dual congenital substrates may converge into a single electrical phenotype.
Take-Home Messages:
An atypical ECG pattern in congenital heart disease may unmask an associated anomaly. Fragmented QRS in Ebstein's anomaly is a potential marker of increased arrhythmic risk.
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