Perinatal management and long-term cardiac outcome in fetal arrhythmia

Hahurij, Nathan D.; Blom, Nico A.; Lopriore, Enrico; Aziz, Mohammad I.; Nagel, H; Rozendaal, L.; Vandenbussche, Frank P.H.A.

doi:10.1016/j.earlhumdev.2010.11.001

Cited by 34 publications

(34 citation statements)

References 25 publications

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“…However, sustained episodes of tachy- or bradyarrhythmia can lead to congestive heart failure, hydrops, or fetal or neonatal demise. Hahurij et al [31] analyzed the causes and outcomes of 44 fetuses with prenatally detected tachy- and bradyarrhythmias after excluding sinus tachycardia, transient sinus bradycardias, premature atrial or ventricular contractions, and ventricular tachycardias. The AVB accounted for 20% (9/44) of these arrhythmias.…”

Section: Resultsmentioning

confidence: 99%

“…The search terms ‘long QT syndrome’, ‘fetal arrhythmia’ and ‘congenital heart disease’ were used. The 30 reports were classified into three categories according to content: 20 reports [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21] describing 21 patients with LQTS documented abnormal cardiac findings found in utero (table 1); 5 reports [23,24,25,26,27] described series of LQTS patients and included prenatal cardiac findings for some of the fetuses (table 2), and 5 reports [28,29,30,31,32] described series of fetuses, some of whom were subsequently diagnosed as having LQTS, for whom echocardiography examinations had been performed because of abnormal cardiac findings detected incidentally during antenatal care (table 3). …”

Section: Methodsmentioning

confidence: 99%

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Fetal Presentation of Long QT Syndrome – Evaluation of Prenatal Risk Factors: A Systematic Review

et al. 2012

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Objective: This systematic review evaluated the existence of risk factors for the fetal manifestation of long QT syndrome (LQTS). Methods: Prenatal cardiac findings suggestive of fetal LQTS were studied using 30 English literature reports extracted from the Pubmed database (1979 to December 2011) using the search terms ‘long QT syndrome’, ‘fetal arrhythmia’ and ‘congenital heart disease’. Results: LQTS accounted for 15–17% of fetal bradycardias <110 bpm among fetuses with a normally structured heart. Of the patients with significant prenatal findings of LQTS, 17–35% exhibited a reduced baseline fetal heart rate (FHR) of 110–120 bpm on electronic cardiotocography. Other prenatal signs were sinus or intermittent bradycardia <110 bpm arising from atrioventricular block, tachyarrhythmias, pleural effusion and hydrops. More than 30% of Japanese infants with LQTS born at or after the mid-1980s exhibited the above-mentioned in utero signs. Conclusions: Fetal factors including a slightly reduced baseline FHR of 110–120 bpm, bradycardia <110 bpm, tachyarrhythmias or clinical signs of heart failure, such as pleural effusion and hydrops, were associated with a higher frequency of LQTS. The use of these signs may help to increase the perinatal diagnosis of LQTS.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Fetal Presentation of Long QT Syndrome – Evaluation of Prenatal Risk Factors: A Systematic Review

et al. 2012

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“…1 Fetal SVT and AF are most commonly accessory pathway-mediated arrhythmias. 2,3 Digoxin as a single agent is not recommended to be used in SVT with accessory pathway because it blocks atrioventricular nodal conduction, and in the presence of an accessory pathway with AF or fibrillation, this might facilitate rapid antegrade conduction over the accessory pathway. 4 Electrophysiologically it would be more desirable to block not only atrioventricular nodal, but also the accessory pathway conduction to achieve clinical response in fetal AF.…”

Section: To the Editormentioning

confidence: 99%

Letter by Uzun et al Regarding Article, “Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin, Flecainide, and Sotalol: Results of a Nonrandomized Multicenter Study”

2012

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compared the efficacy and safety of digoxin, flecainide, and sotalol in fetal tachyarrhythmia. We would consider fetal tachycardia as an emergency, and our treatment of choice is a flecainide and digoxin combination from the outset. We have treated 27 fetuses with flecainide and digoxin combination to date; 6 exhibited atrial flutter (AF), and 21 had supraventricular tachycardia (SVT). Our approach resulted in survival of all fetuses, including 8 (27%) hydropic ones, with no intrauterine death. Twenty-six fetuses (96%) responded to flecainide and digoxin combination, with complete resolution of tachycardia in 22 (81.4%) and rate control in the other 4. 2 The authors observed slower cardioversion rates in AF, fetal hydrops, and incessant arrhythmia, and the arrhythmia-related mortality was 17% in fetal hydrops. 1 Fetal SVT and AF are most commonly accessory pathway-mediated arrhythmias. 2,3 Digoxin as a single agent is not recommended to be used in SVT with accessory pathway because it blocks atrioventricular nodal conduction, and in the presence of an accessory pathway with AF or fibrillation, this might facilitate rapid antegrade conduction over the accessory pathway. 4 Electrophysiologically it would be more desirable to block not only atrioventricular nodal, but also the accessory pathway conduction to achieve clinical response in fetal AF. In case of AF, flecainide without concomitant use of an atrioventricular blocking agent may slow the atrial rate just enough to cause 1:1 conduction over the atrioventricular node, hence resulting in faster ventricular response. Combination treatment with flecainide and digoxin or sotalol would be a logical choice in this respect. We can postulate that digoxin might also provide positive inotropic effect in hydropic fetuses, and its atrioventricular nodal blocking effect might negate potential side effects of flecainide in AF.In our series, we evaluated fetal response time to flecainide and digoxin combination treatment. It was rather encouraging that the sinus rhythm was restored in mean of 4.85 days (range, 1-14 days) in fetuses with SVT. Although the fetal response time in AF was slightly longer with a mean of 10 days (range, 1-18 days), reassuringly all hydropic fetuses had complete resolution of ascites, pleural, and pericardial effusions with rate control. Resolution of hydrops may take as long as 2 weeks after normalization or reduction of fetal heart rate below 160 bpm.Combination treatment was also well tolerated by pregnant women, and there was no serious toxicity requiring withdrawal of antiarrhythmic medication in our experience. 2 The 2-drug combination undoubtedly is more useful in improving fetal hemodynamics by reduction of heart rate to a more tolerable range, or better, by restoring a normal rhythm. 1,2,5 One must acknowledge that the risk of intrauterine death increases when fetal heart failure develops. To counteract such catastrophic end result, rapid restoration or control of fetal heart rate must be the primary objective. We certainly agree that, rat...

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“…Supraventricular tachyarrhythmia (SVT) and atrial flutter (AF) represent the most frequent fetal dysrhythmia with onset during the fetal period [2]. The therapeutic approaches in the prenatal and postnatal period, the immediate and long-term prognosis are different depending on the type of tachyarrhythmia.…”

Section: Introductionmentioning

confidence: 99%

“…Considering this, the tachyarrhythmia diagnosis has to be as close as possible to electrophysiological mechanism. After birth the diagnosis of this pathology is made by interpreting the electrocardiogram, while it is much more difficult to determine an accurate diagnosis during the intrauterine period, and therefore, echocardiography is considered to be the most useful method for this phase [2,3].…”

Section: Introductionmentioning

confidence: 99%

The role of echocardiography in fetal tachyarrhythmia diagnosis. A burden for the pediatric cardiologist and a review of the literature.

et al. 2017

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Supraventricular tachyarrhythmia represents the most frequent fetal dysrhythmia. In the lack of diagnosis and treatment these fetuses may develop hydrops and even death. For the therapeutic approach it is important to establish the diagnosis of the type of supraventricular tachycardia. In this paper we report 29 cases with different types of supraventricular tachycardia in which the diagnosis was established using our own protocol, which allowed us to make the difference between the types of tachycardia (atrioventricular reentry tachycardia due to the accessory pathway, atrial ectopic tachycardia and permanent junctional reciprocal tachycardia). We acquired the data by a series of recordings in M mode and pulsed Doppler by simultaneous recording of an artery and a vein flow. First of all, we diagnosed the supraventricular tachycardia type, with short or long ventriculoarterial interval, and afterwards, we made the difference between atrial ectopic tachycardia and permanent junctional reciprocal tachycardia using methods to decrease the atrioventricular conduction.

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Perinatal management and long-term cardiac outcome in fetal arrhythmia

Cited by 34 publications

References 25 publications

Fetal Presentation of Long QT Syndrome – Evaluation of Prenatal Risk Factors: A Systematic Review

Fetal Presentation of Long QT Syndrome – Evaluation of Prenatal Risk Factors: A Systematic Review

Letter by Uzun et al Regarding Article, “Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin, Flecainide, and Sotalol: Results of a Nonrandomized Multicenter Study”

The role of echocardiography in fetal tachyarrhythmia diagnosis. A burden for the pediatric cardiologist and a review of the literature.

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