{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T18:12:01Z","timestamp":1757614321886,"version":"3.44.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Neonatal bradycardia often triggers transient escape rhythms that challenge clinical diagnosis, with current methods lacking dynamic biomarkers for risk stratification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To validate the \u03bb pattern, a heart rate dynamic signature on time-RR interval scatter plot, for distinguishing escape rhythms from transient sinus bradycardia and predicting recovery timelines in neonates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective analysis of 36 neonates (\u226428 days) with 24\u2005h electrocardiogram (ECG) monitoring. Holter data identified \u03bb patterns (abrupt \u226520% RR prolongation and &amp;gt;3\u2005s gradual recovery). Reverse-engineering ECG validated rhythm origins. Survival models assessed \u03bb burden-prognosis correlations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>487 \u03bb patterns (15.5\u2009\u00b1\u20093.2\/neonate) were detected: 80.3% escape rhythms, 19.7% sinus bradycardia. High \u03bb burden (\u226521\/24\u2005h) predicted delayed recovery vs. low burden (\u226410\/24\u2005h) [HR\u2009=\u20094.22 (95% CI: 1.98\u20139.01), <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001]. All cases resolved spontaneously within 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The \u03bb pattern shows promise as a noninvasive biomarker for stratifying neonatal bradycardia and shows potential to guide recovery timeline prediction. Integration of this approach could optimize neonatal arrhythmia management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1663243","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T06:06:15Z","timestamp":1757052375000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The \u03bb pattern on time-RR interval scatter plot of neonatal ambulatory ECG: a marker of transient bradycardia"],"prefix":"10.3389","volume":"12","author":[{"given":"Hualian","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Wei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengna","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tingting","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.ccep.2018.02.008","article-title":"Neonatal and pediatric arrhythmias: clinical and electrocardiographic aspects","volume":"10","author":"Drago","year":"2018","journal-title":"Card Electrophysiol Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1159\/000087627","article-title":"Asystole and severe bradycardia in preterm infants","volume":"88","author":"Dorostkar","year":"2005","journal-title":"Biol Neonate"},{"key":"B3","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.arcped.2013.10.001","article-title":"Autonomic regulation and bradycardia during the neonatal period","volume":"21","author":"Patural","year":"2014","journal-title":"Arch Pediatr Organe"},{"volume-title":"Junctional Rhythm","year":"2025","author":"Hafeez","key":"B4"},{"key":"B5","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s00431-015-2689-z","article-title":"Evaluation and management of bradycardia in neonates and children","volume":"175","author":"Baruteau","year":"2016","journal-title":"Eur J Pediatr"},{"key":"B6","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s00399-013-0268-4","article-title":"12-lead Holter electrocardiography. 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