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ECG phenomena: alternating QRS morphologies
  1. Christian Paech,
  2. Nicole Pfeil,
  3. Roman Antonin Gebauer
  1. Department for Pediatric Cardiology, University of Leipzig—Heart Center, Leipzig, Germany
  1. Correspondence to Dr Christian Paech, Department for Pediatric Cardiology, University of Leipzig—Heart Center, Strümpellstr. 39, Leipzig 04289, Germany, christian.paech{at}

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A male newborn was referred to our centre for surgery of a hypoplastic left heart syndrome with atresia of the aortic and mitral valve. He received modified Norwood I procedure with patch reconstruction of the aortic arch and pulmonary artery bifurcation as well as implantation of a conduit between RV and pulmonary artery. Postoperative echocardiography showed good ventricular function and no signs of ventricular dyssynchrony.


What is the cause of the two different QRS morphologies? (figure 1)

  1. Pre-excitation

  2. Intermittent bundle branch block (BBB)

  3. Artefact

  4. Twin atrioventricular nodes

  5. Accelerated ventricular rhythm

Figure 1

ECG trace.


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  • Contributors CP: concept and drafting of the manuscript. NP: illustrations and critical revision. RAG: critical revision and approval of the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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