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In repaired tetralogy of Fallot (rTOF), the septal anatomical isthmuses (AI), 3, between the ventricular septal defect (VSD) and pulmonary annulus, and 4, between the VSD and tricuspid annulus, are important ventricular tachycardia (VT) substrates when slow conducting.
The sign has been described in VSD with biventricular hypertrophy in children. It can be seen with isolated VSD as well as complex ventricular septal defect. Katz-Wachtel Phenomenon or Sign on ECG in VSD An ECG with Katz-Wachtel phenomenon is shown here. Himalayan P waves are also described in tricuspid atresia.
And that will be the approximate level of the tricuspid valve, the reference point for measuring right atrial pressure. In right atrial tracing, this occurs at the time of right ventricular contraction, with bulging upwards of the tricuspid valve. The Y descent is shallow in tricuspid stenosis, and absent in cardiac tamponade.
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