Article Text
Concertina effect: a subtle but specific marker
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Description
A 6-year-old boy presented with asymptomatic cardiac murmur and was diagnosed by echocardiography to have a ventricular septal defect. Electrocardiogram (figure 1A,B) showed short PR interval, Δ wave and broad QRS complex suggestive of pre-excitation through right posterior pathway. The electrocardiogram also showed variable conduction with change in cycle length with variable QRS duration and morphology but the ‘P—beginning’ to ‘QRS—end’ duration remained unchanged suggestive of ‘concertina effect’.