The challenge of fetal dysrhythmias: echocardiographic diagnosis and clinical management

Journal of Cardiovascular Medicine
Michele D'AltoRaffaele Calabrò

Abstract

The present study aimed to evaluate the management of fetal cardiac dysrhythmias based on prior identification of the underlying electrophysiological mechanism. We studied 36 consecutive fetuses with cardiac dysrhythmia. Rhythm diagnosis was based on M-mode, pulsed wave Doppler and tissue Doppler imaging (TDI). Only fetuses with: (i) incessant tachycardia (> 12 h) and mean ventricular rate > 200 beats/min, (ii) signs of left ventricular dysfunction, or (iii) hydrops, were treated using oral maternal drug therapy. The mean gestational age at diagnosis was 24.3 +/- 4.5 weeks. Twenty-one fetuses had tachycardia with a 1: 1 atrial-ventricular (AV) conduction. Based on ventricular-atrial interval, prenatal diagnosis was: permanent junctional reciprocating (n = 6), atrial ectopic (n = 6) or atrial-ventricular re-entry tachycardia (n = 9). One had atrial flutter, one ventricular tachycardia and four congenital AV block. Nine showed premature atrial or ventricular beats. Fifteen fetuses with incessant tachycardia, left ventricular dysfunction or hydrops were prenatally treated with maternal administration of digoxin, sotalol or flecainide. The total success rate (sinus rhythm or rate control) was 14/15 (93%). Seven fetuses were hydropi...Continue Reading

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Citations

May 29, 2012·Pediatric Cardiology·Shreya MoodleyGeorge G S Sandor
Apr 27, 2010·Nature Reviews. Cardiology·Janette F Strasburger, Ronald T Wakai
Sep 11, 2008·Current Opinion in Pediatrics·Shardha Srinivasan, Janette Strasburger
Aug 24, 2017·Prenatal Diagnosis·Garick D HillMichele A Frommelt
Aug 20, 2009·Cardiology in the Young·Rajka Lulić JurjevićSamo Vesel
Nov 28, 2018·Pediatric Cardiology·Shi-Min Yuan
Jul 3, 2021·Journal of Clinical Medicine·Alina VedutaPaolo Cavoretto

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