title: Multiple arrhythmias detected during nocturnal monitoring in patients with congenital complete heart block.
abstract: Twenty patients with congenital complete heart block (CHB) were monitored with ECG tape recordings while awake and asleep. Episodes of marked ventricular slowing during sleep (R-R greater than 3000 msec., i.e. less than 20 beats/min) were noted in 35% (7/20). Most of these sudden R-R prolongations were 2:1 or 3:1 exit block of the junctional focus. Atrial and ventricular rate changes were mostly concordant in 2/3 but the remainder demonstrated fixed ventricular rates while atrial rates varied normally, suggesting a "sick" or "lazy" junctional focus. Other arrhythmias were found in 60% (12/20), including several types of rhythms in three patients. One child with previously unsuspected superimposed multiple arrhythmias later had a syncopal episode despite proven supra-Hisian block. The multiple patterns of atrial and ventricular rate changes found indicate complex feedback mechanisms, suggesting that congenital CHB is not a single entity. Since a significant number of patients demonstrated one or another of these unexpected and potentially hazardous findings, we recommend that congenital block patients be carefully studied, including Holter monitoring done on a regular basis.
mesh_terms: D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D001919:Bradycardia / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003936:Diagnosis, Computer-Assisted; D004562:Electrocardiography; D006323:Heart Arrest / Q000175:diagnosis; D006327:Heart Block / Q000151:congenital*; D006801:Humans; D008875:Middle Aged; D012890:Sleep; D013575:Syncope / Q000175:diagnosis; D013610:Tachycardia / Q000175:diagnosis