EKG: Holter recording from a 8 month old baby with cardiomyopathy

Panel 1 - Baseline for comparison.
Panel 2 - What is the reason for change in QRS morphology?
Panel 3 - Based on this panel, do you want to change your opinion for Panel 2?
Panel 4 - How would you differentiate among the following options? (i) Sinus arrhythmia - sinus bradycardia with escape junctional rhythm, (ii) Accelerated junctional rhythm, (iii) Accelerated idioventricular rhythm and (iv) A 5-beat run of ventricular tachycardia.
What is the clinical significance of this finding in an apparently, asymptomatic infant with cardiomyopathy? What if the mother complaints that the baby has been "fussy" recently?

LV Non-compaction

Pignatelli RH, et al.
Circulation 2003;108:2672-8

LVNC - Diagnostic criteria (Adapted from Heart 2001;86:666-71).
All 3 criteria must be present.
1) Multiple deep echocardiographic trabeculations
2)Trabeculations should communicate with ventricular cavity, shown by color Doppler and recesses demonstrated in apical & middle portions of the ventricle
3) Non-compacted to compacted portions ratio >1.4

Angiography images are from Cardiology in the Young 2007;17:56-63

Also, see other posting on this subject.

LV Non-Compaction by Angiogram

4 wk old; Presented with arrhythmia, Circulatory shock and respiratory distress.

Images from Hughes et al. Cardiology in the Young 2007;17:56-63

See also the other posting on this subject.