ECG library
Congenital complete heart block
advanced3 days old· newbornA newborn, day 2, whose mother has systemic lupus with anti-Ro antibodies. The fetal heart rate had been 'slow' on the last two scans. He is pink and feeding.
25 mm/s · 10 mm/mV · synthetic tracing
100%
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.
Key findings
- Newborn ventricular rate near 50
- P waves unrelated to the QRS
- Narrow junctional escape
Learning points
- A well newborn with a heart rate of 50 is a heart block until the ECG says otherwise; the mother's autoantibody status is the first question.
- The decision that matters is pacing: a narrow escape above about 55 in a newborn without heart failure is watched; a rate below that, a wide escape, pauses, or a structurally abnormal heart move the child toward a pacemaker.
- Fetal bradycardia on a scan in a mother with lupus or Sjogren syndrome is the same disease seen earlier.
Connected