Katz-Wachtel phenomenon

Katz-Wachtel phenomenon: Tall diphasic QRS complexes (>50 mm in height) in the mid-precordial leads (leads V2, V3 or V4) typically associated with Biventricular Hypertrophy.

History of Katz-Wachtel phenomenon

1937 – Katz and Wachtel suggested that large diphasic complexes in the standard limb leads were pathognomnic of congenital heart disease. They proposed that the QRS contour may represent combined right and left ventricular ‘strain‘

1963 – Elliott reviewed electrographic and vectorcardiographic criteris for biventricular hypertrophy. They found…

..large diphasic complexes over 50 mm. in either leads V2, V3, V4 were observed in the electrocardiogram of each case of biventricular hypertrophy studied (Katz-Wachtel phenomenon).

Associated Persons

• Louis Nelson Katz (1897 – 1973)
• Hans Wachtel (1909 – 1977)
  

Alternative names

• Katz-Wachtel sign

References

• Katz LN, Wachtel H. The diphasic QRS type of electrocardiogram in congenital heart disease. Am Heart J. 1937; 13: 202-206.
• Elliott LP, Taylor WP, Schiebler GL. Combined ventricular hypertrophy in infancy: Vectorcardiographic observations with special reference to the Katz-Wachtel phenomenon. Am J Cardiol. 1963;11(2):164-172
• Elliott LP, Anderson RC, Tuna N, Adams P, Neufeld HN. Complete Transposition of the Great Vessels: II. An Electrocardiographic Analysis. Circulation; 1963; 27:1118-1127.
• Cadogan M. History of the Electrocardiogram. LITFL

Advanced Reading

Online

• Wiesbauer F, Kühn P. ECG Yellow Belt online course: Become an ECG expert. Medmastery
• Wiesbauer F, Kühn P. ECG Blue Belt online course: Learn to diagnose any rhythm problem. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.

Textbooks

• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Hampton J. The ECG Made Practical 7e, 2019
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Mattu A, Brady W. ECG’s for the Emergency Physician Part I 1e, 2003 and Part II
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004

LITFL Further Reading

• ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
• ECG A to Z by diagnosis – ECG interpretation in clinical context
• ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
• 100 ECG Quiz – Self-assessment tool for examination practice
• ECG Reference SITES and BOOKS – the best of the rest