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Patient
Newborn with prenatal diagnosis of transposition of great vessels; Rashkind intervention at birth with good result; permeable arterial duct; indication of arterial switch;
Trace
Sinus rhythm of 156 beats/minute; probable right atrial enlargement with tall and peaked P wave in lead II; normal PR interval; right ventricular hypertrophy with systolic overload (large R waves throughout the precordium, right axis, inverse T wave in V6);
This young patient underwent arterial switch surgery after 6 days of life; in post-surgery, evidence of a supraventricular rhythm disorder;
Trace
Non-sinus rhythm; tachycardia of 200 beats/minute; common flutter pattern with regular atrial activity of 400 beats/minute; characteristic sawtooth pattern in inferior leads; ventricular rhythm of 200 beats/minute with 2:1 conduction;
Trace
Following surgery, temporary electrodes were left in place on the atrial mass; a rapid pacing of the atrium (pacing stimuli of over 400 beats/minute) enabled a return to sinus rhythm;
Exergue
The velocity of the atrial cycle is dependent on several factors: atrial size (very fast cycles in the newborn, slower cycles in the patient with major atrial dilatation), drug therapy aimed at slowing myocardial conduction and prolonging the cycle.
In the transposition of great vessels, the aorta is in anterior position and emerges from the right ventricle, the pulmonary artery is in posterior position and emerges from the left ventricle.