Notching in electrocardiography

Notching in electrocardiography refers to the presence of distinct deflections or irregularities in the waveform of an electrocardiogram (ECG or EKG), particularly within the P wave, QRS complex (fragmented QRS (fQRS)), or T wave. These notches appear as abrupt changes in the direction or slope of the waveform and can provide critical diagnostic information about cardiac conditions.

Notching in different components of the ECG waveform is associated with various cardiac conditions, ranging from benign variants to serious pathologies, such as conduction delays, atrial fibrillation, myocardial ischemia, or structural heart disease ('crochetage sign' in atrial septal defect (ASD)).

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