Fetal Bradyarrhythmias: Etiopathogenesis, Diagnosis and Treatment: Between Literature Review and Experience of a Tertiary Center (original) (raw)
Related papers
Current Opinion in Pediatrics, 2008
Purpose of review-Though fetal arrhythmias account for a small proportion of referrals to a fetal cardiologist, they may be associated with significant morbidity and mortality. The present review outlines the current literature with regard to the diagnosis and, in brief, some management strategies in fetal arrhythmias. Recent findings-Advances in echocardiography have resulted in significant improvements in our ability to elucidate the mechanism of arrhythmia at the bedside. At the same time, fetal magnetocardiography is broadening our understanding of mechanisms of arrhythmia especially as it pertains to ventricular arrhythmias and congenital heart block. It provides a unique window to study electrical properties of the fetal heart, unlike what has been available to date. Recent reports of bedside use of fetal ECG make it a promising new technology. The underlying mechanisms resulting in immune-mediated complete heart block in a small subset of 'at-risk' fetuses is under investigation. Summary-There have been great strides in noninvasive diagnosis of fetal arrhythmias. However, we still need to improve our knowledge of the electromechanical properties of the fetal heart as well as the mechanisms of arrhythmia to further improve outcomes. Multiinstitutional collaborative studies are needed to help answer some of the questions regarding patient, drug selection and management algorithms.
Fetal Arrhythmia and Related Fetal and Neonatal Outcome
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2021
The evolution of fetal echocardiography (Motion and pulsed Doppler modes) has made possible the antenatal diagnosis of cardiac rhythm anomalies. Fetal cardiac arrhythmias are common anomalies, 20% of which are potentially dangerous. M-mode (motion-mode) echocardiography recording of the fetal heart cannot identify electrical events in the heart, but does depict the mechanical events that succeed them. Pulsed Doppler echocardiography identifies possible arrhythmias over a period of time, allowing for the measurement of these time intervals, a parameter absolutely necessary for the classification of various types of cardiac arrhythmias. Irregular cardiac rhythm (premature atrial contraction, premature ventricular contractions) is the most common disorder seen in practice in specialized fetal echography. These anomalies are usually benign and resolve spontaneously until delivery, thus do not require treatment. Fetal tachyarrhythmia (increased heart rate of 160-189 bpm) is detected by echocardiography, with a wide range of rhythm disorders. It is imperative to understand the mechanism of tachyarrhythmia, so that an accurate and rational management strategy can be formulated in each case. Fetal bradyarrhythmia is characterized by frequent irregular rhythm, low sustained heart rate (10 seconds-few minutes), below 110 bpm, or a combination of both. The diagnosis of the specific bradycardia depends on the echocardiogram findings and the atrioventricular conduction pattern.Once fetal bradycardia is noted, a quick fetal ultrasonographic examination should be performed to assess the normal fetal movements, fetal tone, thus contributing to the diagnosis of fetuses in distress, who require emergency delivery by cesarean section. This paper is an update of the diagnostic approaches in the current practice for different types of fetal heart rhythm disorders, the impact on the fetus and the newborn and their management.
Fetal Bradycardia. A Practical Approach
Fetal and Maternal Medicine Review, 2007
Fetal bradycardia may herald fetal demise. This article highlights arrhythmic fetal bradycardia rather than bradycardia caused by perinatal distress. We briefly examine the embryonic conduction system's development and physiology and we review the classification, aetiology, evaluation, and approach to fetal bradycardia. Our aim is to provide the clinician with practical information about fetal bradycardia that enlightens causative conditions and aids management.
Systematic Appraisal of Diagnosis and Management of Arrhythmias in the Fetus
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
Fetal arrhythmias are one of the most feared clinical problems encountered during the pregnancy that require prompt recognition and effective management by a multidisciplinary team involving fetal medicine specialist, fetal cardiologist, midwife, radiologist, sonographer, neonatologist and the patient herself. This review is aimed at providing a concise guide to medical practitioners involved in the care of pregnant women and the fetus on the diagnosis and management of fetal arrhythmias, follow-up principles and delivery recommendations. How to cite this article Uzun O, Goynumer G, Sen C, Beattie B. Systematic Appraisal of Diagnosis and Management of Arrhythmias in the Fetus. Donald School J Ultrasound Obstet Gynecol 2015;9(3):314-326.
Detection and management of life threatening arrhythmias in the perinatal period
Early Human Development, 2008
The management of tachyarrhythmias and bradyarrythmias in the fetus requires a team approach with careful monitoring of fetal well-being as well as care in establishing a precise diagnosis with use of m-mode and Doppler echocardiography to determine the atrial and ventricular rate. A persistent fetal heart rate less than 80 beats per minute (bpm) suggests complete atrioventricular block. A persistent fetal heart rate over 180 bpm suggests pathological tachycardia, most of which are a supraventricular tachycardia mediated via an accessory pathway. However, around 20% are due to atrial flutter, and this review highlights why medical management should be different for these cases, and for those with hydrops or cardiac failure. It also illustrates which fetus or infant may be at particular risk, and illustrates key features in their management before and after birth.
Cardiology in the Young, 2009
Objectives: to analyse retrospectively the data of fetuses diagnosed with isolated complete atrioventricular block and efficacy of treatment of the fetus by maternal therapy. Materials: Between 1992 and 2004, we diagnosed complete atrioventricular block in 26 singleton and 2 twins fetuses of 27 pregnant women known to have anti Ro/La antibodies, 11 with autoimmune disease, one patient analysed in 2 pregnancies. At presentation, 20 of the fetuses were compensated and non-hydropic, while 8 had hydrops. Twenty patients were treated with dexamethasone, 2 with associated salbutamol and one mother with isoproterenol. Results: Age at presentation was not different between the hydropic and non-hydropic fetuses. The fetuses with hydrops, however, had a lower mean heart rate at presentation, 48.5 6 9.25 with a range from 32 to 60, compared to 59.95 6 7.9 beats per minute, with a range from 50 to 80, in the non-hydropic fetuses (p less than 0.002). Equally, after birth the mean heart rate in hydropic fetuses was 42.6 6 5.1, with a range from 38 to50, as opposed to 56.05 6 11.8 beats per minute, with a range from 29 to 110, in the non-hydropic fetuses (p less than 0.015), The hydropic fetuses were delivered at 31.7 6 3.8 weeks' gestation, with a range from 29 to 38 weeks (p less than 0.003) compared to 35.5 weeks' gestation 62.04, with a range from 31 to 38, in the non-hydropic fetuses. Mortality was 37.5% in the hydropic fetuses, versus 5% of those without hydrops (p less than 0.02). Pacemakers were implanted in 22 of 26 infants born alive, at a median of 45 days, with a range from 1 day to 5 years, in those without hydrops during fetal life, and 3 days, with a range from 1 day to 8 months in those afflicted by hydrops, of whom 2 died despite the implant of the pacemaker. The presence and degree of hydrops had a significantly negative predictive value. No significant differences were observed between the treated and non treated cases, albeit that administration of steroids ameliorated rapidly the hydrops in 3 of 5 cases. Conclusions: The outcome in our cases was mainly dependent on the presence and degree of fetal cardiac failure. Treatment of the fetus by maternal administration of steroids did not result in any regression of the conduction disorder, but had a favourable effect on fetal hydrops.
Diagnosis, Treatment and Follow-up of Fetal Cardiac Arrhythmia
The Journal of Pediatric Research, 2021
Currently, echocardiography represents the most widely used tool for diagnosis and follow-up of fetal arrhythmias in clinical practice. Although non-invasive techniques to record electrophysiological signals from the fetal heart have been
Fetal cardiac arrhythmias: Current evidence
Annals of pediatric cardiology
This article reviews important features for improving the diagnosis of fetal arrhythmias by ultrasound in prenatal cardiac screening and echocardiography. Transient fetal arrhythmias are more common than persistent fetal arrhythmias. However, persistent severe bradycardia and sustained tachycardia may cause fetal hydrops, preterm delivery, and higher perinatal morbidity and mortality. Hence, the diagnosis of these arrhythmias during the routine obstetric ultrasound, before the progression to hydrops, is crucial and represents a challenge that involves a team of specialists and subspecialists on fetal ultrasonography. The images in this review highlight normal cardiac rhythms as well as pathologic cases consistent with premature atrial and ventricular contractions, heart block, supraventricular tachycardia (VT), atrial flutter, and VT. In this review, the details of a variety of arrhythmias in fetuses were provided by M-mode and Doppler ultrasound/echocardiography with high-quality i...