Katz-Wachtel ECG phenomenon

Katz-Wachtel phenomenon (sometimes written as Katz-Wachtel waves).

On ECG:

It refers to the presence of giant, biphasic QRS complexes in the mid-precordial leads (V2–V5).

The QRS complexes are very tall, often more than 50 mm, with both positive and negative deflections in the same complex.

It reflects biventricular hypertrophy (both RVH and LVH present), because forces of both ventricles are so strong and opposing that they produce large biphasic complexes.

Classically described in congenital heart diseases with large left-to-right shunts such as ventricular septal defect (VSD), endocardial cushion defect, or PDA with pulmonary hypertension.

👉 So in one line:

Katz-Wachtel phenomenon = giant biphasic QRS complexes in mid-precordial leads, indicating biventricular hypertrophy, typically seen in large VSD or similar shunt lesions.

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