Fetal tachycardia: Mechanisms and predictors of hydrops fetalis

Naheed, Zahra; Strasburger, Janette F.; Deal, Barbara J.; Benson, D.Woodrow; Gidding, Samuel S.

doi:10.1016/0735-1097(96)00054-x

Cited by 178 publications

(142 citation statements)

References 21 publications

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“…1,2 AVRT is a potentially life-threatening problem in this young age group, and these tachycardias are sometimes difficult to control with antiarrhythmic drug therapy. [3][4][5] However, most tachycardias resolve spontaneously within the first months of life, and Ͼ60% of patients require no antiarrhythmic drug therapy and remain free of symptoms after the age of 1 year. 2,4 This self-limiting character of most perinatal AVRTs suggests that the majority of the APs involved eventually disappear after birth; furthermore, a discontinuation of tachycardia-initiating events may also explain the disappearance of these type of arrhythmias.…”

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confidence: 99%

Accessory Atrioventricular Myocardial Connections in the Developing Human Heart

et al. 2008

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Background-Fetal and neonatal atrioventricular (AV) reentrant tachycardias can be life-threatening but resolve in most cases during the first year of life. The transient presence of accessory AV myocardial connections during annulus fibrosus development may explain this phenomenon. Methods and Results-A total of 45 human embryonic, fetal, and neonatal sectioned hearts (4 to 36 weeks of development)were studied immunohistochemically. Accessory myocardial AV connections were quantified and categorized according to their specific location, and 3D reconstructions were made. Between 4 and 6 weeks of development, the atrial and ventricular myocardium was continuous at the primitive AV canal. At 6 to 10 weeks, numerous accessory myocardial AV connections were identified in the left (45%), right (35%), and septal (20%) regions of the AV junction. Most right-sided accessory connections comprised distinct myocardial strands, whereas left-sided connections consisted of larger myocardial continuities. At 10 to 20 weeks, all accessory AV connections comprised discrete myocardial strands and gradually decreased in number. The majority of accessory connections were located in the right AV junction (67%), predominantly in the lateral aspect (45%). Seventeen percent of the accessory connections were observed in the left AV junction, and 16% were observed in the septal region. 3D reconstructions of the developing AV nodal area at these stages demonstrated multiple AV node-related accessory connections. From 20 weeks until birth, and in neonatal hearts, no further accessory myocardial AV connections were observed. Conclusions-Isolation of the AV junction is a gradual and ongoing process, and right lateral accessory myocardial AV connections in particular are commonly found at later stages of normal human cardiac development. These transitory accessory connections may act as substrate for AV reentrant tachycardias in fetuses or neonates. (Circulation. 2008;117: 2850-2858.)

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confidence: 99%

Accessory Atrioventricular Myocardial Connections in the Developing Human Heart

et al. 2008

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“…19 -21 Postnatal electrophysiological studies of newborns with previously known fetal tachycardia are limited by their retrospective nature and selection bias. 22,23 Because the newborns analyzed in these studies belong to the group of survivors, the mechanisms of the most malignant tachycardias resulting in fetal demise might not be represented in these studies. Whereas tachycardia conversion is generally achieved in nonhydropic fetuses, fetuses with supraventricular tachycardia and hydrops respond less well to empirical antiarrhythmic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Whereas tachycardia conversion is generally achieved in nonhydropic fetuses, fetuses with supraventricular tachycardia and hydrops respond less well to empirical antiarrhythmic therapy. 1,[21][22][23][24][25][26] Premature delivery of this subgroup of patients results in additional complications. 4,5 Therefore, the mortality in this group has been considerable, 1 and accurate definition of the underlying mechanism by fetal transesophageal electrocardiography and stimulation may be helpful.…”

Section: Discussionmentioning

confidence: 99%

Fetoscopic Transesophageal Electrocardiography and Stimulation in Fetal Sheep

et al. 1999

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Background-Therapy-refractory supraventricular tachycardia commonly results in hydrops and death in human fetuses.The purpose of this study in fetal sheep was to assess the feasibility of a minimally invasive fetoscopic approach for fetal transesophageal electrocardiography and stimulation aimed at diagnosis and termination of these tachycardias. Methods and Results -We studied a total of 10 fetal sheep (87 to 103 days of gestation; termϭ145 days). We entered the amniotic cavity using a percutaneous fetoscopic approach and placed various electrophysiology catheters into the fetal esophagus. We recorded the number of animals in which fetoscopic transesophageal electrocardiography and stimulation were successful and assessed pacing success and thresholds for different catheters. In addition, we monitored for potential adverse effects from stimulation and for other complications of the operation. Recording of transesophageal electrocardiograms was successful in all fetal sheep. Capture during stimulation was successfully documented by additional fetal bipolar surface electrocardiograms in 7 fetuses. In fetuses in which fetal surface electrocardiograms were not recorded, pacing stimulus artifacts interfered with documentation of capture. Although stimulation thresholds were high, the maternal rhythm was not affected by fetal stimulation. Conclusions-Fetoscopic

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“…After delivery, antiarrhythmic therapy was withheld unless tachycardia recurred. Twenty-two of 26 infants underwent a TEP procedure 12,13 within 1 week of delivery to determine the mechanism of tachycardia, 14 assess residual amiodarone effect, and guide neonatal antiarrhythmic management. In 4 patients, Holter and telemetry monitoring was sufficient for mechanism assessment.…”

Section: Methodsmentioning

confidence: 99%

Amiodarone Therapy for Drug-Refractory Fetal Tachycardia

et al. 2004

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Background-Fetal tachycardia complicated by ventricular dysfunction and hydrops fetalis carries a significant risk of morbidity and mortality. Transplacental digoxin is effective therapy in a small percentage, but there is no consensus with regard to antiarrhythmic treatment if digoxin fails. This study evaluates the safety, efficacy, and outcome of amiodarone therapy for digoxin-refractory fetal tachycardia with heart failure. Methods and Results-Fetuses with incessant tachycardia and either hydrops fetalis (nϭ24) or ventricular dysfunction (nϭ2) for whom digoxin monotherapy and secondary antiarrhythmic agents (nϭ13) were not effective were treated transplacentally with a loading dose of oral amiodarone for 2 to 7 days, followed by daily maintenance therapy for Ͻ1 to 15 weeks. Digoxin therapy was continued throughout gestation. Newborns were studied by transesophageal pacing or ECG monitoring to determine the mechanism of tachycardia. Three fetuses were delivered urgently in tachycardia during amiodarone loading, and 3 required additional antiarrhythmic agents for sustained cardioversion. Amiodarone or amiodarone combinations converted 14 of 15 (93%) with reentrant supraventricular tachycardia, 2 of 2 with ventricular or junctional ectopic tachycardia, and 3 of 9 (33%) with atrial flutter. Amiodarone-related adverse effects were transient in 5 infants and 8 mothers. Mean gestational age at delivery was 37 weeks, with 100% survival. Conclusions-Orally administered amiodarone is safe and effective treatment for drug-refractory fetal tachycardia, specifically reentrant supraventricular tachycardia, junctional ectopic, or ventricular tachycardia, even when accompanied by hydrops fetalis or ventricular dysfunction.

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Fetal tachycardia: Mechanisms and predictors of hydrops fetalis

Cited by 178 publications

References 21 publications

Accessory Atrioventricular Myocardial Connections in the Developing Human Heart

Accessory Atrioventricular Myocardial Connections in the Developing Human Heart

Fetoscopic Transesophageal Electrocardiography and Stimulation in Fetal Sheep

Amiodarone Therapy for Drug-Refractory Fetal Tachycardia

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