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Broad complex rhythm in neonates: is it always a cause for concern?
  1. Abhishek Oswal1,
  2. Gangadhara Bharmappanavara2,
  3. Georgia Spentzou1
  1. 1 Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, UK
  2. 2 Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
  1. Correspondence to Dr Abhishek Oswal, Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK; abhishekoswal{at}

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A baby born at 37 weeks’ gestation was noted to have premature beats in utero. He was born in good condition. The premature beats were heard intermittently in the first few hours of life. There was no significant family history. He remained well with normal observations and was discharged home after reassurance was provided. At 9 days of age an irregular pulse was noted again during an assessment for jaundice.

On initial assessment, he appeared well. He had an irregular pulse but no other abnormalities in his cardiovascular examination. He required phototherapy for the jaundice. There were no electrolyte abnormalities.

His initial 12-lead electrocardiogram (ECG) showed sinus rhythm with frequent broad-complex beats. A 24-hour ECG (Holter) was performed (see figure 1).

Figure 1

3-lead monitoring from 24-hour Holter ECG monitor.

Test your knowledge

  1. What is the mechanism of the rhythm shown in figure 1?

    1. Ventricular tachycardia

    2. Accelerated idioventricular rhythm

    3. Sinus rhythm …

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  • Contributors AO and GS drafted the initial manuscript. GB provided comments and consented the patient. GS provided supervision and final comments on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.