Electrophysiological Characteristics of Fetal Atrioventricular Block

Zhao, Hui; Cuneo, Bettina F.; Strasburger, Janette F.; Huhta, James C.; Gotteiner, Nina L.; Wakai, Ronald T.

doi:10.1016/j.jacc.2007.06.060

Cited by 96 publications

(98 citation statements)

References 16 publications

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“…No other current method can detect repolarization abnormalities such as T-wave alternans. 331 Over the past decade, fMCG has been reported in case series and has increased the understanding of the pathophysiology of life-threatening arrhythmias such as LQTS, 348 CHB, 330,349,350 and various tachyarrhythmias with or without Wolff-ParkinsonWhite syndrome. 351,352 fMCG has led to modifications in medical therapy of arrhythmias in some cases.…”

Section: Fetal Magnetocardiographymentioning

confidence: 99%

“…351,352 fMCG has led to modifications in medical therapy of arrhythmias in some cases. [329][330][331]353 Unlike fetal electrocardiography, fMCG allows raw signal analysis even in the presence of an irregular rhythm. fMCG holds an inherent advantage over fetal electrocardiography in signalto-noise ratios because the conductance properties of magnetic signals are not affected by poor conductivity of fetal and maternal tissues.…”

Section: Fetal Magnetocardiographymentioning

confidence: 99%

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Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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979

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Fetal Magnetocardiographymentioning

confidence: 99%

Section: Fetal Magnetocardiographymentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

979

543

View full text Add to dashboard Cite

show abstract

“…Although there are no formal guidelines for the type or the frequency of testing, performing weekly pulsed Doppler fetal echocardiography from the 18th through the 26th week of pregnancy and then every other week until 32 weeks has been strongly considered. Additional diagnostic modalities include fetal magnetocardiography and electrocardiography [77,78].…”

Section: Prenatal Screeningmentioning

confidence: 99%

Neonatal Lupus Erythematosus

Nasef

Hafez²,

Bakr³

2014

NCP

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Neonatal lupus is a passively acquired autoimmune disease that occurs in offspring of mothers with anti-SSA/Ro and/or anti-SSB/La antibodies. The primary clinical features are a photosensitive rash that is usually found on the scalp and periorbital areas, congenital heart block with or without cardiomyopathy, cytopenias, disseminated intravascular coagulation, and neonatal cholestasis with or without elevated transaminases. The diagnosis is usually made in utero by detection of a slow fetal heart rate and subsequent fetal echocardiographic confirmation of heart block and/or cardiomyopathy. Prenatal treatment with fluorinated glucocorticoids beginning as soon after detection has favourable outcome for mothers of fetuses with second degree heart block, is of no value for mothers of fetuses with third degree heart block, and controversial for mothers of fetuses with first degree heart block. Prenatal glucocorticoids can be used also in presence of cardiomyopathy associated with neonatal lupus. Hydroxychloroquine has been used in pregnant women who have anti-SSA/Ro antibodies and who have previously given birth to a child with cardiac manifestations. First and second degree block, detected in utero or at birth, can progress to complete heart block. Infants with complete heart block usually require a pacemaker with an excellent prognosis, although development of heart failure may occur.

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“…With earlier detection of more subtle atrioventricular block in the context of maternal autoimmune mediated fetal heart disease, we have begun to better understand the clinical evolution of this disease, its association with other arrhythmias such as junctional ectopic and ventricular tachycardia, and sinus node dysfunction and more diffuse myocardial disease, and to explore strategies to improve the survival of affected fetuses [51][52][53][54][55][56].…”

Section: Fetal Arrhythmiasmentioning

confidence: 99%

“…Maternal autoimmune mediated atrioventricular block accounts for nearly half of affected fetuses with atrioventricular block [100]. To date, although there is no treatment that consistently reverses or prevents atrioventricular block in the context of maternal auto-antibodies SSA/Ro and SSB/La, our eventual goal in this disease, corticosteroids have been used to reduce myocardial inflammation and sympathomimetic therapies have been used to increase the fetal heart rate and improve myocardial performance with variable success [42,51,54]. More recently, recognition of the presence of associated myocardial disease has led to successful treatment with intravenous gamma globulin and corticosteroids in utero and early infancy [56].…”

Section: Fetal Arrhythmia Managementmentioning

confidence: 99%

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

Hornberger

Moon‐Grady²,

Tworetzky³

2012

J Clin Exp Cardiolog

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Fetal echocardiography has evolved considerably over the past 1-2 decades into an exciting field that bridges maternal-fetal medicine with neonatology and pediatric cardiology. With significant advances in imaging technology and experience in prenatal diagnosis, details of the cardiac pathology can now be defined much as it is postnatally; however, unique aspects of the fetal circulation limit our ability to consistently define lesion severity and to predict the evolution of cardiac defects after birth. Serial assessment has provided an understanding of the antenatal natural history of fetal heart disease, which has led to improved counseling and perinatal/neonatal management strategies. More recently, this field has focused on improving our evaluation of fetal arrhythmias, exploring the pathophysiology of fetal heart failure, detecting heart defects at earlier gestational ages, identifying novel interventions to alter the development and progression of severe disease, and investigating strategies to optimize prenatal and neonatal care in an effort to improve perinatal outcome of affected pregnancies. In this paper we will review the current state of the art of fetal/perinatal cardiology and the advances that have occurred in the field largely over the past decade.

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Electrophysiological Characteristics of Fetal Atrioventricular Block

Cited by 96 publications

References 16 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Neonatal Lupus Erythematosus

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

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