classical QRS pattern in ASD is the rsrp Prime in V1 suggestive of incomplete right bundle branch block this pattern in ASD is due to right ventricular volume overload QRS axis is usually rightward more so when there is severe pulmonary hypertension left axis deviation is usually a feature of osum primum ASD first degree a block may be noted in both primum and second M as fam ASD with first degree a block has been reported in second M as this type of fam as has an autosomal dominant inheritance
pattern there is also higher incidence of sudden cardiac death in this group cross attach sign in ASD manifest as notching of rwa near the epex in inferior leads marked by arrows
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