Components of Tetralogy of Fallot (ToF)

  Ventricular septal defect (VSD).

  Obstruction to right ventricular outflow.

  Dextroposition (overriding) of the aorta

  Right ventricular hypertrophy.



ECG abnormalities that are frequently observed in patients with ToF

  Right atrial abnormality ( RAA ).

  Right ventricular hypertrophy ( RVH ).

  Right axis deviation .

  Right bundle branch block ( RBBB ) is frequently observed after corrective surgery. Left anterior fascicular block may accompany.

  Atrial arrhythmias are frequently observed after corrective surgery.

  Ventricular arrhythmias may be observed after corrective surgery.

  If QRS width is > 180 msec, this suggests an increased risk for development of ventricular arryhthmias and sudden cardiac death.



References

  Chou's Electrocardiography in Clinical Practice. Adult and Pediatric. 5th ed. Philadelphia. WB Saunders. 2001.

  Am J Cardiol 1997;80:160.

  Circulation 1995;92:231.

  Circulation 1975;52:691.




ECG 1. The ECG of a 7 years old boy who was operated for ToF one year ago. He is under congestive heart failure therapy.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 2. Above is an ECG from another 7 years-old child.
He had undergone surgery for ToF when he was 4 years-old.
ECHOcardiography showed tricuspid insufficiency and severe pulmonary insufficiency.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG




ECG 3. The ECG above is from a 22 months-old child.
He had undergone surgery for ToF and complete AV canal defect (AVCD).
The second surgery was performed beacuse of residual VSD.
His last ECHOcardiography showed no residual VSD but moderate mitral insufficiency and mild tricuspid insufficiency.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG




ECG 4. Above is an ECG from a 3 years-old child. He had undergone surgery for ToF 2 years ago.
ECHOcardiography showed mild dilation of the right atrium and the right ventricle,
3rd degree pulmonary insufficiency, 2nd degree tricuspid insufficiency.
There are also prolonged PR interval , prolonged QT interval and right bundle branch block .
The underlying rhythm tracing shows sinus arrhythmia.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG




ECG 5. The ECG above belongs to a 4 years-old child.
He had undergone surgery for ToF when he was 4 months old.
Prolonged PR interval and right bundle branch block are seen.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG




ECG 6. The ECG above belongs to a 12 days-old newborn with ToF.
Maximum systolic pulmonary valve gradient was measured as 57 mmHg.
There is also sinus tachycardia with a rate of 177/minute.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

Click here for a more detailed ECG




ECG 7. The ECG above belongs to an 11 years-old child who was operated for ToF.
This patient also has moderate pulmonary stenosis.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 8. Above is an ECG from a 53 days-old baby with ToF.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 9. Above ECG is from an 11 years-old child who had undergone operation for ToF 10 years ago.
After surgery for ToF, he had undergone pulmonary valve replacement for severe pulmonary insufficiency.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 10. Above is an ECG from a 10 months-old baby with ToF (unoperated).

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 11. The above ECG is from a 13 years-old girl. She had undergone operation for ToF in the past.
ECHOcardiography showed normal right ventricular and right atrial dimensions.

Pediatric cardiologist Prof. Dr. Nazlihan Gunal has donated the above ECG to our website.

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ECG 12a. The above ECG is from a 10 years-old boy who had undergone surgery for ToF.
This ECG was recorded in 1996.

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ECG 12b. The ECG above belongs to the same patient.
It was recorded when he was 33 years-old (2019).
ECHOcardiography on the same day with the above ECG showed a dilated and hypokinetic right ventricle.
Right bundle branch block is seen. QRS width is about 160-170 milliseconds.

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