When Ebstein Meets Fallot: A Right-Sided ECG Puzzle

Area of Science:

• Cardiology
• Congenital Heart Disease
• Electrocardiography

Background:

• Tetralogy of Fallot and Ebstein anomaly are complex congenital heart conditions.
• Surgical repair of Tetralogy of Fallot may not address all associated anomalies.
• Electrocardiographic findings can be challenging in patients with multiple congenital heart defects.

Purpose of the Study:

• To describe a unique case of overlapping electrocardiographic features in a patient with Tetralogy of Fallot and Ebstein anomaly.
• To illustrate the diagnostic utility of electrocardiography in complex congenital heart disease.
• To investigate potential markers for arrhythmic risk in Ebstein anomaly.

Main Methods:

• Case report of a 14-year-old male patient.
• Analysis of electrocardiographic (ECG) findings.
• Review of patient's congenital heart disease history and surgical repair.

Main Results:

• The patient presented with ventricular fibrillation following repair of Tetralogy of Fallot and Ebstein anomaly.
• ECG showed features of both conditions: right bundle branch block and right ventricular hypertrophy (Tetralogy of Fallot), and broad P waves, AV block, and fragmented QRS (Ebstein anomaly).
• The electrocardiographic pattern represented a convergence of dual congenital substrates into a single electrical phenotype.

Conclusions:

• Atypical ECG patterns in congenital heart disease can unmask associated anomalies.
• Fragmented QRS complexes in Ebstein anomaly may serve as a marker for increased arrhythmic risk.
• This case underscores the importance of comprehensive ECG interpretation in managing complex congenital heart disease.