Hostname: page-component-6bf8c574d5-r8w4l Total loading time: 0 Render date: 2025-03-07T02:28:28.662Z Has data issue: false hasContentIssue false
  • English
  • Français

Wide complex rhythm in a well neonate: Where are the P waves?

Published online by Cambridge University Press:  04 May 2023

Gabrielle Jee Open the ORCID record for Gabrielle Jee [Opens in a new window] ,
Amos Wong ,
Victor Ofoe  and
Orhan Uzun
Gabrielle Jee
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
Amos Wong
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
Victor Ofoe
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK
Orhan Uzun*
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, UK Cardiff University School of Medicine, Cardiff, UK
*
Corresponding author: Prof. O. Uzun, Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, UK. Tel: +442920744749. E-mail: Uzun@cardiff.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

A neonate was seen for an evolving broad QRS complex rhythm initially captured at birth as intermittent escape beats on electrocardiogram. Continuous monitoring recorded features mimicking pre-excitation, but closer analysis revealed a regular broad QRS complex rhythm with isorhythmic atrioventricular dissociation, favouring a ventricular source. Treatment with flecainide and propranolol achieved successful control of the incessant arrhythmia with improvement in cardiac function on echocardiogram.

Keywords

Neonatearrhythmiaaccelerated idioventricular rhythm
Type
Brief Report
Information
Cardiology in the Young , Volume 33 , Issue 10 , October 2023 , pp. 2124 - 2127
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Riera, A, Barros, R, de Soussa, F, Baranchuk, A. Accelerated idioventricular rhythm: history and chronology of the main discoveries. Indian Pacing Electrophysiol J 2010; 10: 40–48. Retrieved January 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803604/pdf/ipej100040-00.pdf Google ScholarPubMed
Freire, G, Dubrow, I. Accelerated idioventricular rhythm in newborns: a worrisome but benign entity with or without congenital heart disease. Pediatr Cardiol 2008; 29: 457–462. Retrieved from http://link.springer.com/10.1007/s00246-007-9024-z 10.1007/s00246-007-9024-zCrossRefGoogle ScholarPubMed
Reynolds, JL, Pickoffrid, AS. Accelerated ventricular rhythm in children: a review and report of a case with congenital heart disease. Pediatr Cardiol 2001; 22: 23–28.CrossRefGoogle ScholarPubMed
Fouron, JC. Fetal arrhythmias: the Saint-Justine hospital experience. Prenat Diagn 2004; 24: 1068–1080.10.1002/pd.1064CrossRefGoogle ScholarPubMed
Martini, B, Nava, A, Thiene, G, et al. Accelerated idioventricular rhythm of infundibular origin in patients with a concealed form of arrhythmogenic right ventricular dysplasia. Heart 1988; 59: 564–571.CrossRefGoogle ScholarPubMed
Anatoliotaki, M, Papagiannis, J, Stefanaki, S, Koropouli, M, Tsilimigaki, A. Accelerated ventricular rhythm in the neonatal period: a review and two new cases in asymptomatic infants with an apparently normal heart. Acta Paediatr 2007; 93: 1397–1400.CrossRefGoogle Scholar
Bisset, GS, Janos, GG, Gaum, WE. Accelerated ventricular rhythm in the newborn infant. J Pediatr 1984; 104: 247–249.CrossRefGoogle ScholarPubMed
Kothari, DS. Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed 2006; 91: F136–F144.10.1136/adc.2004.049049CrossRefGoogle ScholarPubMed
Ban, JE. Neonatal arrhythmias: diagnosis, treatment, and clinical outcome. Korean J Pediatr 2017; 60: 344.CrossRefGoogle ScholarPubMed
Beach, C, Marcuccio, E, Beerman, L, Arora, G. Accelerated idioventricular rhythm in a child with status asthmaticus. Pediatrics 2015; 136: e527–e529.10.1542/peds.2015-0449CrossRefGoogle Scholar
Ergul, Y, Kafali, HC, Uysal, F. Accelerated idioventricular rhythm resulting in torsades de pointes and cardiac arrest in a child: successfully cryoablated in left’coronary cusp. Cardiol Young 2020; 30: 418–421.10.1017/S1047951119002993CrossRefGoogle Scholar
Crosson, JE, Callans, DJ, Bradley, DJ, et al. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11: e55–e78.10.1016/j.hrthm.2014.05.010CrossRefGoogle ScholarPubMed
Hohnloser, SH, Zabel, M, Olschewski, M, Kasper, W, Just, H. Arrhythmias during the acute phase of reperfusion therapy for acute myocardial infarction: effects of β-adrenergic blockade. Am Heart J 1992; 123: 1530–1535.10.1016/0002-8703(92)90805-6CrossRefGoogle ScholarPubMed