Hemodynamic Effects of Chronic Prenatal Ventricular Pacing for the Treatment of Complete Atrioventricular Block

Abstract

We conclude that chronic epicardial ventricular pacing is well tolerated by the fetus, can be successfully applied as a treatment for CAVB, and does not adversely affect myocardial function in the rapidly developing, immature heart.

Arrhythmias in the developing heart

“…In principle, foetal pacemaker implantation (Liddicoat et al . ) should be considered using minimally invasive techniques (Sydorak et al . , Eghtesady et al .…”

“…For significant number of foetuses with complete heart block caused by maternal autoantibodies, transplacental treatment with beta-receptor-stimulating agents, corticosteroids or immunosuppressives is recommended. In principle, foetal pacemaker implantation (Liddicoat et al 1997) should be considered using minimally invasive techniques (Sydorak et al 2001, Eghtesady et al 2011, Nicholson et al 2012.…”

Operative techniques and strategies for minimally invasive fetoscopic fetal cardiac interventions in sheep

“…Fetal cardiac bypass, pacemaker implantation, and cryosurgical atrioventricular nodal ablation are all feasible in fetal sheep [3,7,9,22,26,27]. Unfortunately, even though they are technically straightforward, open fetal cardiac surgical approaches are associated with significant maternal and fetal morbidity, because fetal cardiac access requires maternal laparotomy and hysterotomy as well as fetal thoracotomy.…”

Current Status of Fetal Cardiac Intervention

“…2 Subsequently, animal models were developed to evaluate pacing for fetal AV block, but this has not become a clinically viable treatment strategy, isolated human cases notwithstanding. 59–62 Human FCI aided by fetoscopy and cardioscopy has also been reported, with technical success and fetal survival in several cases. 7,15,16 We are aware of 1 open heart surgery performed in a third-trimester human fetus with tricuspid valve dysplasia, severe tricuspid regurgitation, and hydrops by Dr Frank Hanley in 2003 (personal communication, June 6, 2009).…”