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Structured inpatient evaluation of neonatal cardiac ectopy

Abstract

Objective(s)

In well-appearing newborns with suspected cardiac ectopy, we sought to evaluate our practice and test whether initial electrocardiogram (ECG) findings were associated with neonatal arrhythmias (NA).

Study design

We identified well-appearing, non-anomalous infants >34 weeks’ gestation with suspected ectopy over 3.5 years. NA was defined as ≥10% premature atrial contractions (PAC), ≥5 beats of atrial tachycardia, ≥2% premature ventricular contractions (PVCs), or ≥3 beats of ventricular tachycardia. The unadjusted associations between initial ECG findings and NA are reported.

Result

Among 126 infants with ECGs and Holters performed, NA was observed in 38 patients (30%) and was similar whether PACs were present or not on the initial ECG (33% vs. no PACs: 29%, p = 0.6). However, NAs were identified more frequently based on the presence of PVCs on the initial ECG (83% vs. 25%, p < 0.01).

Conclusion

NAs were prevalent and both their etiologies and impact on infants warrant future study.

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References

  1. Turner CJ, Wren C. The epidemiology of arrhythmia in infants: a population-based study. J Paediatr Child Health. 2013;49:278–81.

    Article  PubMed  Google Scholar 

  2. Copel JA, Liang R, Demasio K, Ozeren S, Kleinman CS. The clinical significance of the irregular fetal heart rhythm. Obstet Gynecol. 2000;182:813–9.

    CAS  Google Scholar 

  3. Dubin AM. Arrhythmias in the Newborn. NeoReviews . 2000;1:e146.

    Article  Google Scholar 

  4. Tschudy, Megan M, Arcara, Kristin M., eds. The Harriet Lane Handbook: A Manual For Pediatric House Officers, 19th Edition. Philadelphia, PA : Mosby Elsevier, 2012. Print. P. 127.

  5. Montague TJ, Taylor PG, Stockton R, Roy DL, Smith ER. The spectrum of cardiac rate and rhythm in normal newborns. Pediatr Cardiol. 1982;2:33–8.

    Article  PubMed  CAS  Google Scholar 

  6. Respondek M, Włoch A, Kaczmarek P, Borowski D, Wilczynski J, Helwich E. Diagnostic and perinatal management of fetal extrasystole. Pediatr Cardiol. 1997;18:361–6.

    Article  PubMed  CAS  Google Scholar 

  7. Laurent G, Saal S, Amarouch MY, Béziau DM, Marsman RF, Faivre L, et al. Multifocal ectopic Purkinje-related premature contractions: a new SCN5A-related cardiac channelopathy. J Am Coll Cardiol. 2012;60:144–56.

    Article  PubMed  Google Scholar 

  8. Miga DE, Case CL, Gillette PC. Interatrial septal aneurysms and atrial arrhythmias in infants. Am Heart J. 1996;132:776–8.

    Article  PubMed  CAS  Google Scholar 

  9. Paech C, Gebauer RA. ECG phenomena: pseudopreexcitation and repolarization disturbances resembling ST‐elevation myocardial infarction caused by an intraatrial rhabdomyoma in a newborn. Congenit Heart Dis. 2014;9:E66–9.

    Article  PubMed  Google Scholar 

  10. Calvin SE, Gaziano EP, Bendel RP, Knox GE, Brandt DG. Evaluation of fetal cardiac arrhythmias. Ultrasound findings and neonatal outcome. Minn Med. 1992;75:29–31.

    PubMed  CAS  Google Scholar 

  11. Check J, Gotteiner N, Liu X, Su E, Porta N, Steinhorn R, et al. Fetal growth restriction and pulmonary hypertension in premature infants with bronchopulmonary dysplasia. J Perinatol. 2013;33:553–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. Mestan KK, Check J, Minturn L, Yallapragada S, Farrow KN, Liu X, et al. Placental pathologic changes of maternal vascular underperfusion in bronchopulmonary dysplasia and pulmonary hypertension. Placenta. 2014;35:570–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Wren C. Cardiac arrhythmias in the fetus and newborn. Semin Fetal Neonatal Med. 2006;11:182–90.

    Article  PubMed  Google Scholar 

  14. Davignon A, Rautaharju P, Boisselle E, Soumis F, Mégélas M, Choquette A. Normal ECG standards for infants and children. Pediatr Cardiol. 1980;1:123–31.

    Article  Google Scholar 

  15. Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, 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:e55–78.

    Article  PubMed  Google Scholar 

  16. Southall DP, Richards J, Mitchell P, Brown DJ, Johnston PG, Shinebourne EA. Study of cardiac rhythm in healthy newborn infants. Br Heart J. 1980;43:14–20.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Author contributions

Study design (IH, KMu, GW); operational expertise, including data sources (IH, KMu, KMa); neonatology review (KMu, EG, KMa), neonatal cardiology and electrophysiology review, ECG interpretation (NG, AC, GW), analysis (IH, GW, KMu); first paper draft (IH); all authors revised the manuscript critically for substantive content and approved the final version.

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Correspondence to Karna Murthy.

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The authors declare that they have no conflict of interest.

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Hurst, I.A., Webster, G., Machut, K.Z. et al. Structured inpatient evaluation of neonatal cardiac ectopy. J Perinatol 38, 696–701 (2018). https://doi.org/10.1038/s41372-018-0089-8

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  • DOI: https://doi.org/10.1038/s41372-018-0089-8

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