Fetal arrhythmias: Diagnosis and management

Batra, Anjan S.; Balaji, Seshadri

doi:10.1016/j.ipej.2019.02.007

Cited by 18 publications

(19 citation statements)

References 35 publications

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“…15 Congenital heart block generally occurs at 18-24 weeks of gestation, can appear as fetal bradycardia which can be detected by routine fetal auscultation, ultrasound, or pulsed Doppler echocardiography. 16 There is no guideline on the frequency of examinations, some carry out Doppler examinations for 18-26 weeks and every 2 weeks after 32 weeks of age. 11 The therapy is expected to reduce maternal autoantibodies, thereby reducing placental transfer and reducing inflammation before permanent fibrosis and irreversible CHB occur.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive management of pregnant woman with Sjögren’s syndrome

Gunawan

Rahadina

Prasetyo

2022

MOG

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HIGHLIGHTS 1. Sjögren’s syndrome is a chronic autoimmune disease that attacks the exocrine glands, especially lacrimal and salivary glands. 2. Comprehensive management of pregnant women with Sjögren’s syndrome was described.3. Clinical and laboratory examination, risk assessment and also preconception counseling before planning pregnancy are needed by women with Sjögren’s syndrome. ABSTRACT Objective: To illustrate the comprehensive management of pregnant women with Sjögren syndrome. Case Report: A 24 years old women came to Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, due to Sjögren syndrome in 35/36 weeks of gestasional age for routine examination. She was first diagnosed with Sjögren syndrome in February 2018 because she complained of dry eyes and hair fall out. This was her first pregnancy. Laboratory result showed positive ANA test. The patient had hypertension with controlled blood preasure and dry eyes. The patient was diagnosed with primigravida 35-36 weeks of pregnancy, single live intrauterine, head presentation, IUGR, screening preeclampsia was positive, and there was complication with Sjögren’s syndrome. The patient was treated by multidisciplinary team consisting of obstetricians, internists, ophthalmologists and neonatologists. Conclusion: Sjögren’s syndrome is a chronic autoimmune disease that attacks the exocrine glands, especially lacrimal and salivary glands. The exact cause of Sjögren's syndrome is still not known. Women with Sjögren’s syndrome should have clinical and laboratory examination, risk assessment and also preconception counseling before planning pregnancy because Sjögren syndrome was a rare case during pregnancy. Close monitoring and proper management was imperative to detect the early complication.

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Section: Discussionmentioning

confidence: 99%

Comprehensive management of pregnant woman with Sjögren’s syndrome

Gunawan

Rahadina

Prasetyo

2022

MOG

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“…Congenital LQTS, which is an autoimmune antibody-negative fetal bradycardia, is a cause of fetal AVB ( Otsuki et al, 2020 ). The occurrence of AVB in concert with LQTS is not due to disease of the conduction system itself but rather due to the prolonged ventricular repolarization time that leads to atrial activation before ventricular repolarization is complete ( Batra and Balaji, 2019 ). Generally, QT interval prolongation is responsible for bradycardia ( Oka et al, 2010 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: A novel KNCH2 variant-induced fetal heart block and the advantages of fetal genomic sequencing in prenatal long-term dexamethasone exposure

Huang

Jing

et al. 2022

Front. Genet.

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Background: Fetal bradycardia is a common but severe condition. In addition to autoimmune-mediated fetal heart block, several types of channelopathies induce high-degree atrioventricular block (AVB). Long QT syndrome (LQTS) is a major cause of non-autoimmune-mediated fetal heart block. Due to the limitations of prenatal diagnostic technologies, LQTS is seldom identified unless fetal genetic screening is performed. Thus, long-term prenatal dexamethasone (DEX) exposure can become a challenge for these patients. We report on a rare case of a novel KCNH2 variant related to LQTS and associated with high-degree fetal AVB with long-term DEX exposure. This case led us to review our prenatal administration strategy for such patients.Case Presentation: A fetus was identified with high-degree AVB (2:1 transduction at 28 + 2 gestational weeks). Typical tests of immune function in the pregnant woman were conducted including tests for thyroid function, rheumatic screening, autoimmune antibodies (such as anti-Ro/SSA and anti-La/SSB), and anti-nuclear antibodies (anti-ANA). Following the recommended protocol, the pregnant patient received DEX (0.75 mg/day) during pregnancy. Subsequently, the fetal AVB changed from 2:1 to prolonged AV intervals with ventricular tachycardia, which suggested a therapeutic benefit of DEX in some respects. However, a high-degree AVB with a significantly prolonged QTc interval was identified in the neonate following birth. Genetic testing revealed that a KCNH2 c.1868C>A variant induced LQTS. The body length remained approximately -3.2 SD from the reference value after prenatal long-term DEX exposure, which indicated a developmental restriction. Additionally, the functional validation experiments were performed to demonstrate the prolonged duration of calcium transit both in depolarization and repolarization with the KCNH2 c.1868C>A variant.Conclusion: Genetic screening should be recommended in fetuses with autoimmune antibody negative high-degree AVB, especially for 2:1 transduction AVB and in fetuses with changes in fetal heart rhythm following initial DEX treatment. Genetic screening may help identify genetic variant–related channelopathies and avoid unexpected prenatal exposure of DEX and its possible long-term adverse postnatal complications.

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“…As idiopathic miscarriage occurs in 15% of the background population, the case of miscarriage, described by Miyoshi et al, might not be related to the preceding ICD discharge [ 19 ]. In contrast to ICD shocks, transthoracic shocks were reported to result in severe, sustained fetal bradycardia [ 53 ]. It has been hypothesized that the uterus is a likely good conductor of electricity and contracts following transthoracic shocks.…”

Section: Discussionmentioning

confidence: 99%

Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review

Topf

Bacher

Kopp

et al. 2021

JCM

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Background: With the advent of implantable cardioverter-defibrillator (ICD) technology in recent decades, patients with inherited or congenital cardiomyopathy have a greater chance of survival into adulthood. Women with ICDs in this group are now more likely to reach reproductive age. However, pregnancy represents a challenge for clinicians, as no guidelines for the treatment of pregnant women with an ICD are currently available. Methods: To analyze this issue, we performed a systematic screening of the literature using the keywords: pregnancy with ICD, lead fracture in pregnancy, lead thrombi in pregnancy, ventricular tachycardia in pregnancy, inappropriate shocks in pregnancy, ICD discharge in pregnancy and ICD shock in pregnancy. Of 1101 publications found, 27 publications were eligible for further analysis (four retrospective trials and 23 case reports). Results: According to physiological changes in pregnancy, resulting in an increase in heart rate and cardiac output, a vulnerability for malignant arrhythmias and device-related complications in ICD carriers might be suspected. While the literature is limited on this issue, maternal complications including arrhythmia burden with following ICD therapies, thromboembolic events and lead complications as well as inappropriate shock therapy have been reported. According to the limited available studies, associated risk seems not to be more frequent than in the general population and depends on the underlying cardiac pathology. Furthermore, worsening of heart failure and related cardiovascular disease have been reported with associated risk of preterm delivery. These observations are exaggerated by restricted applications of diagnostics and treatment due to the risk of fetal harm in this population. Conclusions: Due to limited data on management of ICDs during pregnancy, further scientific investigations are required. Consequently, careful risk assessment with individual risk evaluation and close follow ups with interdisciplinary treatment are recommended in pregnant ICD carriers.

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Fetal arrhythmias: Diagnosis and management

Cited by 18 publications

References 35 publications

Comprehensive management of pregnant woman with Sjögren’s syndrome

Comprehensive management of pregnant woman with Sjögren’s syndrome

Case Report: A novel KNCH2 variant-induced fetal heart block and the advantages of fetal genomic sequencing in prenatal long-term dexamethasone exposure

Management of Implantable Cardioverter-Defibrillators during Pregnancy—A Systematic Review

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