Fetal tachyarrhythmia with 1:1 atrioventricular conduction. Adenosine infusion in the umbilical vein as a diagnostic test

Abstract

This is the report of a case of fetal tachyarrhythmia with 1:1 atrioventricular conduction detected by pre-natal echocardiography in a fetus at 25-weeks gestation. Adenosine infusion via cordocentesis was performed as a diagnostic test to differentiate between atrioventricular nodal reentrant supraventricular tachyarrhythmia and atrial flutter. After infusion, transient 2:1 atrioventricular dissociation was obtained and the diagnosis of atrial flutter was made. Transplacental therapy with digoxin and amiodarone was then successfully used.

Catheter ablation of typical right atrial flutter in a 20‐day‐old neonate with tachycardiomyopathy

“…Fetal supraventricular arrhythmias are linked to 1%–5% of those with rhythm disorders having congenital heart disease 5 . In some cases, periods of 1:1 AV conduction in AFL can occur due to fetal stress, as previously reported by our team in an era when adenosine infusion via the umbilical vein was employed for differential diagnosis of flutter and AVRT 6 . Nevertheless, such elevated heart rates are typically short‐lived during the neonatal period due to evolving hemodynamics 7 .…”

“… 5 In some cases, periods of 1:1 AV conduction in AFL can occur due to fetal stress, as previously reported by our team in an era when adenosine infusion via the umbilical vein was employed for differential diagnosis of flutter and AVRT. 6 Nevertheless, such elevated heart rates are typically short‐lived during the neonatal period due to evolving hemodynamics. 7 The most frequent congenital heart defect (CHD) associated with AFL is atrial septal defect.…”