Fetal arrhythmias

Simpson, John

doi:10.1002/uog.2819

Cited by 51 publications

(45 citation statements)

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“…Bei weniger als 10% der überwiesenen Patientinnen handelt es sich um klinisch relevante Herzrhythmusstörungen wie stabile Tachyarrhythmie (fetale Herzfre quenz >180/min) oder Bradyarrhythmie (fetale Herzfrequenz <100/min), die ggf. eine pränatale Behandlung notwendig machen [26].…”

Section: Rhythmusstörungen Beim Fetusunclassified

“…In den meisten Fällen der Patienten, die sich mit der Diagnose einer fetalen Herz rhythmusstörung in den Perinatalzentren vorstellen, werden isolierte fetale Extra systolien, meistens ektopische vorzeitige Vorhofkontraktionen, diagnostiziert, wel che hämodynamisch keine relevante pa thologische Auswirkung auf das Kind ha ben und deshalb keine antiarrhythmische Therapie brauchen [26]. Im Falle einer fetalen Tachyarrhythmie (.…”

Section: Rhythmusstörungen Beim Fetusunclassified

“…Eine Regurgitation durch die AVKlappe, Abnahme des "re versed flow" in der V. cava inferior kombi niert mit einer langen kompensatorischen Pause sind die Merkmale einer ventriku lären Ektopie [26,27]. Im MMode findet man weiterhin eine vorzeitige ventriku läre Aktivität.…”

Section: Ventrikuläre Extrasystolienunclassified

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Herzrhythmusstörungen bei der Schwangeren und beim Fetus

Trappe

Tchirikov

2008

Internist

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For the acute treatment of supraventricular (SVT) and ventricular tachycardias (VT) in pregnant women, electrical cardioversion with 50-100 J is indicated in all unstable patients. In stable SVT the initial therapy includes vagal maneuvers or intravenous adenosine. For long-term therapy, beta-blocking agents with beta(1)-selectivity are first-line drugs or specific anti-arrhythmic drugs. An implantable cardioverter-defibrillator is another approach. In patients with symptomatic bradycardia, a pacemaker can be implanted using echocardiography at any stage of pregnancy. Evaluation of fetal arrhythmias in clinical practice is based on assessment of the chronological relationship between atrial and ventricular contraction (M-mode and Doppler ultrasound or magnetocardiography). Most forms of SVT can be treated with transplacental administration of anti-arrhythmic drugs. Atrioventricular (AV) block in fetuses with structural heart disease is frequently associated with hydrops fetalis and intrauterine death. Administration of corticoids and beta-mimetic drugs is used to treat antibody-mediated AV block and cardiomyopathy.

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Section: Rhythmusstörungen Beim Fetusunclassified

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Herzrhythmusstörungen bei der Schwangeren und beim Fetus

Trappe

Tchirikov

2008

Internist

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“…An estimated 0.4% to 0.6% of pregnancies have a fetal arrhythmia at some point during the pregnancy. 2,3 Although the vast majority are not of clinical significance and require no treatment, a much smaller percentage have a sustained tachyarrhythmia that can be life-threatening to the fetus. The most frequent serious arrhythmias in the fetus are supraventricular, most commonly from atrioventricular reentry tachycardia involving an accessory atrioventricular connection (supraventricular tachycardia [SVT]) or atrial flutter, but occasionally from atrioventricular node reentry (also SVT) or ectopic atrial tachycardia.…”

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“…The most frequent serious arrhythmias in the fetus are supraventricular, most commonly from atrioventricular reentry tachycardia involving an accessory atrioventricular connection (supraventricular tachycardia [SVT]) or atrial flutter, but occasionally from atrioventricular node reentry (also SVT) or ectopic atrial tachycardia. 2,3 Here, we refer to all these mechanisms together as supraventricular arrhythmias (SVAs) and the subgroups of interest as SVT or atrial flutter. Importantly, SVAs can lead to tachycardia-induced cardiomyopathy because of prolonged decreased cardiac output and myocardial fatigue, which can lead to hydrops fetalis and rare fetal death, 2,3 as reviewed by Jaeggi et al 1 Treatment options include careful observation, maternal drug therapy, or delivery of the fetus.…”

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Can We Do a Prospective Trial for Fetal Tachycardia?

Saul

Cain

2011

Circulation

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have added to the literature with their extensive assessment of 159 fetal tachyarrhythmia cases collected from 3 institutions over a 10-year period. However, before we comment on their study, it is worth reviewing some of the relevant issues for management of fetal arrhythmias. An estimated 0.4% to 0.6% of pregnancies have a fetal arrhythmia at some point during the pregnancy. 2,3 Although the vast majority are not of clinical significance and require no treatment, a much smaller percentage have a sustained tachyarrhythmia that can be life-threatening to the fetus. The most frequent serious arrhythmias in the fetus are supraventricular, most commonly from atrioventricular reentry tachycardia involving an accessory atrioventricular connection (supraventricular tachycardia [SVT]) or atrial flutter, but occasionally from atrioventricular node reentry (also SVT) or ectopic atrial tachycardia. 2,3 Here, we refer to all these mechanisms together as supraventricular arrhythmias (SVAs) and the subgroups of interest as SVT or atrial flutter. Importantly, SVAs can lead to tachycardia-induced cardiomyopathy because of prolonged decreased cardiac output and myocardial fatigue, which can lead to hydrops fetalis and rare fetal death, 2,3 as reviewed by Jaeggi et al. 1 Treatment options include careful observation, maternal drug therapy, or delivery of the fetus. Article see p 1747More than 20 studies have looked at outcomes of drug therapy for fetal SVA, some of which are reviewed by Jaeggi et al. 1 The most commonly used antiarrhythmics are digoxin, flecainide, sotalol, and amiodarone, but many drugs have been used less frequently, and results vary widely. In the studies using digoxin as first-line therapy, successful conversion has been reported in 50% to 100% of fetuses without hydrops, but only 0% to 20% of patients with hydrops. 4 -9 Flecainide has resulted in sinus rhythm in 58% to 100% of fetuses without hydrops and 43% to 56% of those with hydrops, 6,10,11 whereas sotalol has been successful 40% to 100% of the time without hydrops and 50% of the time in fetuses with hydrops. 12,13 Finally, amiodarone had conversion success in 50% to 93% of fetuses with SVA. 7,14,15 The results from the larger of these studies also often vary by SVA mechanism, SVT versus atrial flutter. Despite the varied results, this brief summary makes a few points clear: (1) No single agent is universally effective; (2) the presence of hydrops makes conversion less likely; and (3) the literature is confounded by data from only retrospective studies of series biased by physician and institutional preferences. Consequently, without controlled efficacy data, there can be no clear guidelines for the treatment of fetal tachycardias.The study in this month's journal by Jaeggi et al 1 is a retrospective review of 159 patients managed for fetal SVA, of whom 111 underwent first-line drug therapy with digoxin (nϭ24), sotalol (nϭ52), or flecainide (nϭ35). Patients who were started on combined therapy with digoxin plus either sotalol or flecainide were place...

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Fetal Medical Conditions

Brennand

2012

Dewhurst's Textbook of Obstetrics &Amp; Gynaecology

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Fetal arrhythmias

Cited by 51 publications

References 55 publications

Herzrhythmusstörungen bei der Schwangeren und beim Fetus

Herzrhythmusstörungen bei der Schwangeren und beim Fetus

Can We Do a Prospective Trial for Fetal Tachycardia?

Fetal Medical Conditions

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