Transplacental fetal therapy for junctional ectopic tachycardia

Abstract

Junctional ectopic tachycardia (JET) is a rare type of tachyarrhythmia. A 39-year-old woman was transferred to our hospital for fetal tachyarrhythmia at 32 weeks' gestation. Fetal cardiac sonography revealed atrial and ventricular rates of 120-130 and 175-230 bpm, respectively, without 1:1 atrioventricular relationship. As ventricular tachycardia was considered to be the most probable diagnosis, transplacental therapy with digoxin and sotalol was done with partial response. Diagnosis of JET was made after birth. Although fetal JET is rare and prenatal diagnosis and treatment of this condition is still a challenge, differential diagnosis of fetal tachyarrhythmia should include this disorder.

Gestão pré-natal e resultados da taquicardia juncional ectópica acelerado e hidropisia

“…Junctional ectopic tachycardia is usually seen in children during the immediate postoperative period of congenital heart surgery. The congenital form is less frequent and has rarely been reported prenatally 7,8 . Congenital JET is believed to be caused by an automatic ectopic focus in the AV junction 3 .…”

“…The outcome in congenital JET shows that is a malignant tachyarrhythmia causing tachycardia-induced cardiomyopathy and sudden death 6 . Because of the limited efficiency of most antiarrhythmic medications in JET, the intrauterine management of such cases is difficult and should aim at maintaining adequate cardiac output to allow prolongation of the pregnancy until lung maturation is achieved 7,8 . In addition, the presence of hydrops in our case suggested an unfavorable prognosis, despite the fact that, before digoxin therapy, tachyarrhythmia was episodic and ventricular rate rarely exceeded 190 beats/min.…”

“…While post-surgical JET has a mortality up to 14%, congenital JET has a mortality up to 34% 6 . The congenital form of JET has rarely been reported during the prenatal period 7,8 . We describe a case in which the diagnosis was suspected in utero in a patient referred to our Department because of the presence of important fetal ascitis.…”