Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T07:35:24.223Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias

Published online by Cambridge University Press:  18 August 2009

Rajka Lulić Jurjević ,
Tomaž Podnar  and
Samo Vesel
Rajka Lulić Jurjević
Affiliation:
Cardiology Unit, Children’s Hospital Srebrnjak, Zagreb, Croatia
Tomaž Podnar
Affiliation:
Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Ljubljana, Slovenia
Samo Vesel*
Affiliation:
Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Ljubljana, Slovenia
*
Correspondence to: Dr Samo Vesel, Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Bohoriceva 20, SI-1000 Ljubljana, Slovenia. Tel: +386 1 522 9332; Fax: +386 1 522 9357; E-mail: samo.vesel@mf.uni-lj.si
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To evaluate the diagnosis, clinical features, management and post-natal follow-up in consecutive fetuses identified with tachycardia.

Methods

We reviewed consecutive fetuses with tachycardia identified in a single tertiary institution between January, 2001, and December, 2008. We considered several options for management, including no treatment but close surveillance, trans-placental antiarrhythmic therapy in fetuses presenting prior to 36 weeks of gestation, and delivery and treatment as a neonate for fetuses presenting after 36 weeks of gestation. Data was gathered by a review of prenatal and postnatal documentation.

Results

Among 29 fetuses with tachycardia, 21 had supraventricular tachycardia with 1 to 1 conduction, 4 had atrial flutter, 3 had atrial tachycardia, while the remaining fetus had ventricular tachycardia. Of the group, 8 fetuses (27.6%) were hydropic. Transplacental administration of antiarrhythmic drugs was used in just over half the fetuses, delivery and treatment as a neonate in one-quarter, and no intervention but close surveillance in one-sixth of the case. Twenty-six of 29 fetuses (89.7%) were born alive. Only patients with fetal hydrops suffered mortality, with 37.5% of this group dying, this being statistically significant, with the value of p equal to 0.03, when compared to non-hydropic fetuses. Only 3 patients (11.5%) were receiving antiarrhythmic prophylaxis beyond the first year of life.

Conclusion

A significant proportion of fetal tachycardias recognized before 36 weeks of gestation can be treated successfully by transplacental administration of antiarrhythmic drugs. Fetuses presenting after 36 weeks of gestation can be effectively managed postnatally. The long-term prognosis for fetuses diagnosed with tachycardia is excellent, with the abnormal rhythm resolving spontaneously during the first year of life in most of them.

Keywords

Fetal medicinearrhythmiaoutcome
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 5 , October 2009 , pp. 486 - 493
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Southall, DP, Richards, J, Hardwick, RA, Shinebourne, A, Gibbens, GLD, Thelwall-Jones, H, et al. Prospective study of fetal heart rate and rhythm patterns. Arch Dis Child 1980; 55: 506–511.Google Scholar
2. Boldt, T, Eronen, M, Andersson, S. Long-term outcome in fetuses with cardiac arrhythmias. Obstet Gynecol 2003; 102: 1372–1379.Google ScholarPubMed
3. Kleinman, CS, Nehgme, RA. Cardiac arrhythmias in the human fetus. Pediatr Cardiol 2004; 25: 234–251.Google Scholar
4. Hornberger, LK, Sahn, DJ. Rhythm abnormalities of the fetus. Heart 2007; 93: 1294–1300.CrossRefGoogle ScholarPubMed
5. Krapp, M, Kohl, T, Simpson, JM, Sharland, GK, Katalinic, A, Gembruh, U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 2003; 89: 913–917.CrossRefGoogle ScholarPubMed
6. Eronen, M, Siren, MK, Ekblad, H, Tikanoja, T, Julkunen, H, Paavilainen, T. Short- and long-term outcome of children with congenital complete heart block diagnosed in utero or as a newborn. Pediatrics 2000; 106: 86–91.CrossRefGoogle ScholarPubMed
7. Jaeggi, ET, Hornberger, LK, Smallhorn, J, Fouron, JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary centres and review of the literature. Ultrasound Obstet Gynecol 2005; 26: 16–21.Google Scholar
8. Lopes, LM, Tavares, GM, Damiano, AP, Lopes, MA, Aiello, VD, Schultz, R, et al. Perinatal outcome of fetal atrioventricular block: one-hundred-sixteen cases from a single institution. Circulation 2008; 118: 1268–1275.Google Scholar
9. Jaeggi, ET, Nii, M. Fetal brady- and tachyarrhythmias: new and accepted diagnostic and treatment methods. Semin Fetal Neonat Med 2005; 10: 504–514.CrossRefGoogle ScholarPubMed
10. Simpson, JM. Fetal arrhythmias. Ultrasound Obstet Gynecol 2006; 27: 599–606.CrossRefGoogle ScholarPubMed
11. Allan, LD, Anderson, RH, Sullivan, ID, Campbell, S, Holt, DW, Tynan, M. Evaluation of fetal arrhythmias by echocardiography. Br Heart J 1983; 50: 240–245.CrossRefGoogle ScholarPubMed
12. Kleinman, CS, Donnerstein, RL, Jaffe, CC, De Vore, GR, Weinstein, EM, Lynch, DC, et al. Fetal echocardiography: a tool for evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy: analysis of 71 patients. Am J Cardiol 1983; 51: 237–242.CrossRefGoogle Scholar
13. Allan, LD, Chita, SK, Sharland, GK, Maxwell, D, Priestly, K. Flecainide in the treatment of fetal tachycardias. Br Heart J 1991; 65: 46–48.Google Scholar
14. Simpson, JM, Sharland, GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79: 576–581.CrossRefGoogle ScholarPubMed
15. Oudjik, MA, Michon, MM, Kleinman, CS, Kapusta, L, Stoutenbeek, P, Visser, GHA, et al. Sotalol in the treatment of fetal dysrhythmias. Circulation 2000; 101: 2721–2726.CrossRefGoogle Scholar
16. Krapp, M, Baschat, AA, Gembruch, U, Geipel, A, Germer, U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2002; 19: 158–164.CrossRefGoogle ScholarPubMed
17. Fouron, JC, Fournier, A, Proulx, F, Lamarche, J, Bigras, JL, Boutin, C, et al. Management of fetal tachyarrhythmias based on superior vena cava/aorta Doppler flow recordings. Heart 2003; 89: 1211–1216.CrossRefGoogle ScholarPubMed
18. Strasburger, JF, Cuneo, BF, Michon, MM, Gotteiner, NL, Deal, BJ, Oudijk, MA, et al. Amiodarone therapy for drug – refractory fetal tachycardia. Circulation 2004; 109: 375–379.CrossRefGoogle ScholarPubMed
19. Van Engelen, AD, Weitens, O, Brenner, JI, Kleinman, CS, Copel, JA, Stoutenbeek, P, et al. Management, outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 1994; 24: 1371–1375.CrossRefGoogle ScholarPubMed
20. D’Alto, M, Russo, MG, Paladini, D, Di Salvo, G, Romeo, E, Ricci, C, et al. The challenge of fetal dysrhythmias: echocardiographic diagnosis and clinical management. J Cardiovasc Med 2008; 9: 153–160.CrossRefGoogle ScholarPubMed
21. Oudijk, MA, Ruskamp, JM, Ambachtsheer, BE, Ververs, PS, Visser, GHA, Meijboom, EJ. Drug treatment of fetal tachycardias. Pediatr Drugs 2002; 4: 49–63.Google Scholar
22. Gembruch, U, Redel, DA, Bald, R, Hansmann, M. Longitudinal study in 18 cases of fetal supraventricular tachycardia: Doppler – echocardiographic findings and pathophysiological implications. Am Heart J 1993; 125: 1290–1301.Google Scholar
23. Api, O, Carvalho, JS. Fetal dysrhythmias. Best Pract Res Clin Obstet Gynecol 2008; 22: 31–48.CrossRefGoogle ScholarPubMed
24. Taylor, MJ, Smith, MJ, Thomas, M, Green, AR, Cheng, F, Oseku-Afful, S, et al. Non-invasive fetal electrocardiography in singleton and multiple pregnancies. BJOG 2003; 110: 668–678.Google Scholar
25. Wakai, RT, Strasburger, JF, Li, Z, Deal, BJ, Gotteiner, NL. Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia. Circulation 2003; 107: 307–312.Google Scholar
26. Fouron, JC, Proulx, F, Miro, J, Gosselin, J. Doppler and M-mode ultrasonography to time fetal atrial and ventricular contractions. Obstet Gynecol 2000; 96: 732–736.Google Scholar
27. Carvalho, JS, Prefumo, F, Ciardelli, V, Sairam, S, Bhide, A, Shinebourne, EA. Evaluation of fetal arrhythmias from simultaneous pulsed wave Doppler in pulmonary artery and vein. Heart 2007; 93: 1448–1453.Google Scholar
28. Rein, AJ, O’Donnell, C, Geva, T, Nir, A, Perles, Z, Hashimoto, I, et al. Use of tissue velocity imaging in the diagnosis of fetal cardiac arrhythmias. Circulation 2002; 106: 1827–1833.CrossRefGoogle ScholarPubMed
29. Hansmann, M, Gembruch, U, Bald, R, Manz, M, Redel, DA. Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases. Ultrasound Obstet Gynecol 1991; 1: 162–170.Google Scholar
30. Frohn-Mulder, IM, Stewart, PA, Witsenburg, M, Den Hollander, NS, Wladimiroff, JW, Hess, J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diag 1995; 15: 1297–1302.CrossRefGoogle ScholarPubMed
31. Benson, DW, Dunnigan, A, Benditt, DG. Follow-up evaluation of infant paroxysmal atrial tachycardia: transesophageal study. Circulation 1987; 75: 542–549.CrossRefGoogle ScholarPubMed
32. Drago, F, Silvetti, MS, De Santis, A, Marcora, S, Fazio, G, Anaclerio, S, et al. Paroxysmal reciprocating supraventricular tachycardia in infants: electrophysiologically guided medical treatment and long-term evolution of the re-entry circuit. Europace 2008; 10: 629–635.CrossRefGoogle ScholarPubMed
33. Casey, FA, McCrindle, BW, Hamilton, RM, Gow, RM. Neonatal atrial flutter: significant early morbidity and excellent long-term prognosis. Am Heart J 1997; 133: 302–306.CrossRefGoogle ScholarPubMed
34. Sonesson, SE, Winberg, P, Lidegran, M, Westgren, M. Foetal supraventricular tachycardia and cerebral complications. Acta Peadiatr 1996; 85: 1249–1252.CrossRefGoogle ScholarPubMed
35. Schade, RP, Stoutenbeek, P, de Vries, LS, Meijboom, EJ. Neurological morbidity after fetal supraventricular tachyarrhythmia. Ultrasound Obstet Gynecol 1999; 13: 43–47.Google Scholar
36. Oudijk, MA, Gooskens, RHJM, Stoutenbeek, P, de Vries, LS, Meijboom, EJ. Neurological outcome of children who were treated for fetal tachycardia complicated by hydrops. Ultrasound Obstet Gynecol 2004; 24: 154–158.CrossRefGoogle ScholarPubMed