Clinical Outcome and Circulatory Effects of Fetal Cardiac Arrhythmia

Abstract

ABSTRACT. By means of abdominal fetal ECG and non‐invasive ultrasound blood flow studies 113 cases of fetal cardiac arrhythmia were classified according to the origin of arrhythmia. Pregnancy outcome was characterized by an increased frequency of fetal distress and heart malformation, and increased fetal and neonatal mortality. The following types of arrhythmia were identified: supraventricular extrasystoles (n=84), paroxysmal tachycardia (n=6), sinus bradycardia (n=3), atrial flutter (n=1), ventricular extrasystolw (n=14), and atrioventricular block (n=5). In 37 cases the combined Doppler and real‐time ultrasound tehnique was used to measure fetal aortic blood flow as a means of studying the circulatory effects of the arrhythmia. Increased peak velocity, risiig slope and acceleration were found in the first post‐pausal beat after a supraventricular extrasystole or a missed beat; this supports the validity of Frank‐Starling law for the fetal heart and suggests that a strong relationship exists between these variables and myocardial contractility, In two cases of intra‐uterine heart failure, the effect of digoxin treatment in utero on the fetal aortic flow variables was studied, results indicating a positive inotropic effect of the drug on the fetal myocardium. The estimation of fetal aortic volume blood flow in cases of fetal cardiac arrhythmia is useful for early detection of fetal cardiac failure, and for monitoring the effects of intra‐uterine treatment.

Case report: Prenatal diagnosis of fetal non-compaction cardiomyopathy with bradycardia accompanied by de novo CALM2 mutation

“…Fetal bradyarrhythmia, which is defined as a heart rate of <110 bpm and mainly includes sinus bradycardia (16.9%) and AV block (38.2%) ( 14 ), is related to fetal hypoxia, abnormal heart structure, and maternal connective tissue disease. Sustained bradyarrhythmia can lead to cardiac function impairment manifesting as cardiac effusion in the fetus ( 15 ), as in the present case, suggesting a poor prognosis. Fetal echocardiography is the most commonly used method for diagnosing fetal arrhythmia.…”

Hepatic venous Doppler in the evaluation of fetal extrasystoles

“…Reed et al 3 reported premature atrial contractions in 76 (94%) and premature ventricular contractions in five cases. Lingman et al 18 reported premature contractions of atrial origin in 94 (87%) cases and of venous origin in 14 using combined Doppler and abdominal fetal ECG.…”

Fetal Dual Doppler Echocardiography

“…Premature atrial contractions (PACs) account for 90% extrasystoles and are usually identified in second or third trimester fetuses. 17 PACs are defined as premature beats originating from the atria, which might be either conducted (generating a ventricular contraction) or blocked (not conducted through the atrioventricular node) ( Figs 3A and B). Premature atrial contractions are usually benign, resolving before or shortly after birth, but 1 to 5% fetuses with PACs develop supraventricular tachycardia, which can lead to compromise.…”