Fetal Cardiac Repolarization Abnormalities

Zhao, Hui; Strasburger, Janette F.; Cuneo, Bettina F.; Wakai, Ronald T.

doi:10.1016/j.amjcard.2006.03.026

Cited by 52 publications

(48 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

Self Cite

925

543

View full text Add to dashboard Cite

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.

show abstract

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

925

543

View full text Add to dashboard Cite

show abstract

“…Notably, although none of the children had a QTc above the upper limit of normality (440 ms); these authors underlined how in one of the studied families, a sudden infant death had occurred in a sibling of a child with CHB. Furthermore, magnetocardiography-based electrophysiological observations on 15 foetuses with complete AV block (80% anti-Ro ⁄ SSA-La ⁄ SSB antibody-positive) demonstrated significant repolarization abnormalities, including QTc prolongation [30]. Finally, Duke et al [31] reported the case of a foetus from an anti-Ro ⁄ SSA-positive mother, developing both CHB and ventricular tachycardia: interestingly, the post-natal evaluation of this child revealed prolongation of the QT interval.…”

Section: Pathogenetic Mechanismsmentioning

confidence: 99%

Anti-Ro/SSA Antibodies and Cardiac Arrhythmias in the Adult: Facts and Hypotheses

Lazzerini

Capecchi

Laghi-Pasini

2010

Scandinavian Journal of Immunology

View full text Add to dashboard Cite

It is well established that the passive trans‐placental passage of anti‐Ro/SSA antibodies from mother to foetus is associated with the risk to develop an uncommon syndrome named neonatal lupus (NLE), where the congenital heart block represents the most severe clinical feature. Recent evidence demonstrated that also adult heart, classically considered invulnerable to the anti‐Ro/SSA antibodies, may represent a target of the arrhythmogenicity of these autoantibodies. In particular, the prolongation of the QTc interval appears the most frequent abnormality observed in adults with circulating anti‐Ro/SSA antibodies, with some data suggesting an association with an increased risk of ventricular arrhythmias, also life threatening. Moreover, even though the association between anti‐Ro/SSA antibodies and conduction disturbances is undoubtedly less evident in adults than in infants, from the accurate dissection of the literature data the possibility arises that sometimes also the adult cardiac conduction tissue may be affected by such antibodies. The exact arrhythmogenic mechanisms involved in foetus/newborns and adults, respectively, have not been completely clarified as yet. However, increasing evidence suggests that anti‐Ro/SSA antibodies may trigger rhythm disturbances through an inhibiting cross‐reaction with several cardiac ionic channels, particularly the calcium channels (L‐type and T‐type), but also the potassium channel hERG, whose different expression and involvement in the cardiac electrophysiology during lifespan might account for the occurrence of age‐related differences.

show abstract

“…Fetal TWA has been occasionally observed in studies on magnetocardiographic recordings [1,2,6] that underlie the potential importance of fetal TWA assessment as a result of the high incidence of TWA in fetuses with cardiac arrhythmias and suboptimal outcomes [1]. Moreover, also in fetuses TWA is often observed in association with QT prolongation; thus, an accurate long QT syndrome diagnosis linked to TWA identification might permit an efficient treatment in utero [1,6]. Therefore, fetal TWA is potentially the cause of some nowadays unexplained fetal demises and its detection might become the key to solve many currently unexplained severe problems, some of which leading fetus to death.…”

Section: Introductionmentioning

confidence: 99%

“…Most of them render the heart susceptible to lethal ventricular tachyarrhythmias, at any age, also before birth [1]. T-wave abnormalities manifest in a lot of different forms, among which T-wave alternans (TWA) has received particular attention because strongly related to sudden cardiac death [2].…”

Section: Introductionmentioning

confidence: 99%