Congenital heart disease electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Keri Shafer, M.D. [2],Atif Mohammad, M.D., Priyamvada Singh, MBBS

ECG has been found to be of little help in diagnosing congenital heart malformation in premature and newborn infants. However, in older children they are of some use. Some of the ECG findings and their indications are as follows:

  • After 3 days of life a persistently elevated T wave may suggest a right ventricular hypertrophy.
  • Counterclockwise superior oriented QRS with reduced right ventricular force suggests tricuspid atresia.
  • Counterclockwise superior oriented QRS suggests endocardial cushion defects.
  • Normal QRS with predominant left ventricular force suggests pulmonic atresia.
  • It can pick rhythm disturbances like supraventricular tachycardia and complete heart block.
  • A MI pattern on ECG may suggest an anomalous pulmonary origin of the coronary artery.
  • Depressed or flattened T wave in the lateral precordium suggests subendocardial ischemia.

2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines[1]

Recommendations for Electrocardiogram

The ECG, like other aspects of the physical examination, is an important part of a thorough cardiovascular evaluation of a patient with ACHD. An aberrant baseline ECG is expected in many forms of CHD, especially those who have undergone surgical repair, hence it's crucial to collect one regardless of the anatomic diagnosis in order to compare it to any later ECGs. A follow-up ECG is advised in cases of certain lesions, as well as when congestion is developing, getting worse, or there is a low cardiac output syndrome.

Class I
1.A standard 12-lead electrocardiogram (ECG) is recommended in adults with CHD with serial assessment depending on the specific ACHD AP classification or when symptoms develop or worsen. (Level of Evidence C-EO)
2.Ambulatory electrocardiographic monitoring should be performed in patients with CHD who are at risk of tachyarrhythmia, bradyarrhythmia or heart block, or when symptoms possibly of arrhythmic origin develop. (Level of Evidence C-EO)


  1. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM; et al. (2019). "2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (12): 1494–1563. doi:10.1016/j.jacc.2018.08.1028. PMID 30121240.

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