Probable causes of ECG abnormalities in Ebstein’s anomaly were investigated by comparing tracings from 18 young patients with the disease (group I) and 20 age-matched patients with a morphologically similar cardiopathy: right ventricular endomyocardial fibrosis (group II). Tall p waves (≧ 2.5 mm) occurred in about a third of the patients in each group and were attributable to right atriomegaly. 8 patients, 4 from each group, had prolonged P-R intervals (≧ 17 s) resulting from increased P-R segment (7 cases) and prolonged P-wave duration (4 cases). Right bundle branch block was, however, more prevalent in group I (44%) than in group II (5 %), and is thought to result mainly from a paucity of conduction fibres in the atrialized right ventricle in Ebstein’s anomaly and partly, in group II especially, from septal fibrosis. In both groups R-wave deflections in V3R and VI were reduced, probably because of a clockwise cardiac rotation and paucity of right ventricular muscle mass.

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