Case Report: Adenosine-induced atrioventricular dissociation: unmasking monomorphic tachycardia as a diagnostic challenge in a neonate
Year: 2025
Type: article
Study design: Case Report
Abstract: Background: Neonatal monomorphic tachycardia poses a diagnostic challenge. This report demonstrates how adenosine-induced AV dissociation confirmed ventricular tachycardia. Case: A 3-day-old preterm neonate (34 + 2 weeks) presented with refractory monomorphic tachycardia (217 bpm; QRS 92 ms) initially diagnosed as SVT based on 1:1 retrograde P-waves. Adenosine administration induced atrioventricular dissociation without termination-a finding inconsistent with SVT. Retrospective ECG analysis revealed prolonged QRS duration during tachycardia (92 ms vs. 60 ms post-cardioversion) and delta wave-like slurring, confirming VT diagnosis. Synchronized cardioversion (0.5 J/kg) restored sinus rhythm, followed by metoprolol prophylaxis. Conclusion: This case highlights that monomorphic tachycardia in neonates may represent VT. Adenosine's role in inducing AV dissociation is pivotal for diagnosis, and low-energy cardioversion with β-blocker maintenance offers an effective rescue strategy. Clinicians must reassess ECG features dynamically to avoid misclassification.
Source: Frontiers in Pediatrics
Authors: Feifei Wang, Bin Wu, Jiaqi Huang, Ba Yaletai, Peng Liu
Institutions: Inner Mongolia Medical University, Qingdao Municipal Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W4415567287