ArticleFrontiers in pediatrics2025
Case Report: Adenosine-induced atrioventricular dissociation: unmasking monomorphic tachycardia as a diagnostic challenge in a neonate.
Article in Frontiers in pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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