Obstetric importance, diagnosis, and management of fetal tachycardias.

Maxwell, D.; Crawford, Douglas L.; Curry, Philip; Tynan, Michael; Allan, Lindsey D.

doi:10.1136/bmj.297.6641.107

Cited by 109 publications

(21 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, drug treatment was used for the vast majority of patients in this series, even when the fetus was non-hydropic. Although preterm delivery and postnatal treatment avoids the uncertainty of placental transfer of drugs, our previous experience10 and that of other investigators1 2 has shown a high mortality and high incidence of complications in fetuses managed in this way. In this series there was a 9.7% mortality for hydropic fetuses in whom the arrhythmia was controlled prenatally, versus 56% in those in whom the arrhythmia was not controlled.…”

Section: Discussionmentioning

confidence: 92%

Fetal tachycardias: management and outcome of 127 consecutive cases

Simpson

Sharland

1998

Heart

269

240

View full text Add to dashboard Cite

Objective-To review the management and outcome of fetal tachycardia, and to determine the problems encountered with various treatment protocols. Study design-Retrospective analysis. Subjects-127 consecutive fetuses with a tachycardia presenting between 1980 and 1996 to a single tertiary centre for fetal cardiology. The median gestational age at presentation was 32 weeks (range 18 to 42). Results-105 fetuses had a supraventricular tachycardia and 22 had atrial flutter. Overall, 52 fetuses were hydropic and 75 non-hydropic. Prenatal control of the tachycardia was achieved in 83% of treated non-hydropic fetuses compared with 66% of the treated hydropic fetuses. Digoxin monotherapy converted most (62%) of the treated non-hydropic fetuses, and 96% survived through the neonatal period. First line drug treatment for hydropic fetuses was more diverse, including digoxin (n = 5), digoxin plus verapamil (n = 14), and flecainide (n = 27). The response rates to these drugs were 20%, 57%, and 59%, respectively, confirming that digoxin monotherapy is a poor choice for the hydropic fetus. Response to flecainide was faster than to the other drugs. Direct fetal treatment was used in four fetuses, of whom two survived. Overall, 73% (n = 38) of the hydropic fetuses survived. Postnatally, 4% of the nonhydropic group had ECG evidence of preexcitation, compared with 16% of the hydropic group; 57% of non-hydropic fetuses were treated with long term antiarrhythmics compared with 79% of hydropic fetuses. Conclusions-Non-hydropic fetuses with tachycardias have a very good prognosis with transplacental treatment. Most arrhythmias associated with fetal hydrops can be controlled with transplacental treatment, but the mortality in this group is 27%. At present, there is no ideal treatment protocol for these fetuses and a large prospective multicentre trial is required to optimise treatment of both hydropic and non-hydropic fetuses. (Heart 1998;79:576-581)

show abstract

Section: Discussionmentioning

confidence: 92%

Fetal tachycardias: management and outcome of 127 consecutive cases

Simpson

Sharland

1998

Heart

269

240

View full text Add to dashboard Cite

show abstract

“…When evaluation of the publications of one centre revealed case overlap, the most recent studies were selected 1 2 7 and previous articles [14][15][16][17] were excluded from the review. Our data were retrieved from a recent publication 12 and were completed by previously published 18 19 and unpublished data.…”

Section: Study Populationmentioning

confidence: 99%

Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia

Krapp

2003

Heart

182

126

View full text Add to dashboard Cite

Objective: To review the diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Design: Retrospective review of published reports: 11 papers about fetal tachyarrhythmia published between 1991 and 2002 were selected for review. Main outcome measures: All selected studies were analysed for the type of arrhythmia, degree of atrioventricular block in atrial flutter, occurrence of hydrops fetalis, gestational age at diagnosis, first and second line drug treatment, associated cardiac and extracardiac malformations, and mortality of the fetuses. Results: Atrial flutter accounted for 26.2% of all cases of fetal tachyarrhythmias, and supraventricular tachycardia for 73.2%. Hydrops fetalis was reported in 38.6% and 40.5% of fetuses with atrial flutter and supraventricular tachycardia, respectively (NS). Hydropic fetuses with atrial flutter had higher ventricular rates (median 240 beats/min, range 240-300) than non-hydropic fetuses (220 beats/min, range 200-310) (p = 0.02), whereas the atrial rates were not significantly different (median 450 beats/min, range 370-500). Digoxin treatment resulted in a higher conversion rate in non-hydropic fetuses with fetal tachyarrhythmias than in hydropic fetuses (p < 0.001). The overall mortality of atrial flutter was similar to that of supraventricular tachycardia, at 8.0% v 8.9% (p = 0.7). Conclusions: The prevalence of hydrops fetalis did not differ in fetal atrial flutter and supraventricular tachycardia with 1:1 conduction. There was no difference between the response rate to digoxin in fetus with atrial flutter or supraventricular tachycardia. Mortality was similar in the two types of tachyarrhythmia.A ccording to published reports, atrial flutter accounts for a fifth to a third of all fetal tachyarrhythmias. 1 2 Fetal atrial flutter is defined as a rapid regular atrial rate of 300-600 beats/min accompanied by variable degrees of atrioventricular (AV) conduction block, resulting in slower ventricular rates. Previous data have suggested that fetal atrial flutter carries a worse prognosis than fetal supraventricular tachycardia (SVT) with 1:1 AV conduction, because of difficulties in controlling this rhythm disorder and the likelihood of associated congenital cardiac malformations.3 In contrast, Simpson and Sharland recently reported that the outcome of fetal tachyarrhythmias depends on the presence or absence of hydrops fetalis but not on the type of arrhythmia.2 Our aim in the present study was to review the diagnosis, treatment, and outcome of fetal atrial flutter compared with SVT. METHODS Study populationFor the review, data were collected from publications about fetal tachyarrhythmias published from 1990 onwards. Eleven papers about fetal tachyarrhythmia 1 2 4-12 were selected from the Medline database according to the following criteria:• only articles with more than 10 cases of fetal tachyarrhythmia were included • all publications had to contain data about consecutive cases of fetal tachyarrhythmia.• articles dealing with isola...

show abstract

“…Such management problems are aggravated if the infant is preterm, and it has therefore been recommended that a trial of inutero therapy for a fetal arrhythmia may be better than early delivery. '3 14 Unfortunately in our patient sustained supraventricular tachycardia was not detected by two antenatal scans. An irregular fetal heart rhythm due to atrial or ventricular extrasystoles is common and is generally dismissed as a benign funding unconnected with structural abnormality.…”

Section: Discussionmentioning

confidence: 57%