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Intensive Care Nursery House Staff Manual
Intensive Care Nursery House Staff Manual
Intensive Care Nursery House Staff Manual
Tachyarrhythmia Bradyarrhythmia
narrow-QRS wide-QRS
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Copyright © 2004 The Regents of the University of California
Neonatal Cardiac Arrhythmias
I. Reentry tachycardias
Diagnosis Findings on ECG Treatment
Atrial flutter -"Sawtooth" flutter waves -Unstable: esophageal pacing or
-AV block does not terminate atrial rhythm electrical cardioversion
-Atrial rate up to 500 in newborns
-Variable AV conduction common -Stable: digoxin, propranolol,
or digoxin + procainamide
Accessory pathway mediated -P follows QRS, typically on upstroke of T
tachycardia (WPW) -Superior or rightward P wave axis
-AV block always terminates tachycardia -Unstable: esophageal pacing or
-Typically terminates with P wave electrical cardioversion
-After termination, WPW have pre-excitation
-Stable: vagal maneuvers.
Permanent form of junctional -Incessant - P wave precedes QRS adenosine
reciprocating tachycardia (PJRT) -Inverted P waves in II, III, AVF propranolol or digoxin
-AV block always terminates tachycardia
-May terminate with QRS or P wave -No response: procainamide or
-No pre-excitation after termination flecainide
Atrioventricular node reentry -P usually not visible, superimposed on QRS
-AV block usually terminates tachycardia.
Atrial and sinoatrial reentry -P present, precedes next QRS -Unstable: electrical cardioversion
-Terminates with QRS rather than P -Stable: propranolol, procainamide
-AV block does not terminate atrial rhythm or amiodarone
-P axis may be superior or inferior
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Copyright © 2004 The Regents of the University of California
Neonatal Cardiac Arrhythmias
C. Bradyarrhythmias:
Sinus bradycardia -Slow atrial rate with normal P waves -Vigorous resuscitation and
-1:1 conduction supportive care
-Due to underlying causes such as hypoxia, -A B C
acidosis, increased intracranial pressure, -O2
abdominal distension, hypoglycemia, -Treat underlying causes
hypothermia, digoxin, propranolol
Atrioventricular block -Atrioventricular dissociation -Unstable: A B C
-Regular R-R intervals O2
Complete atrioventricular block -Regular P-P intervals Atropine, isoproterenol
-Atrial rate > ventricular rate infusion
-P which occur after T have no effect on Temporary trans-
R-R interval venous pacing
-Infants of maternal lupus -Stable: Treat underlying causes
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Copyright © 2004 The Regents of the University of California