The clinical significance of the irregular fetal heart rhythm

Copel, Joshua A.; Liang, Ren Ing; Demasio, Kafui; Özeren, Semih; Kleinman, Charles S.

doi:10.1016/s0002-9378(00)70330-9

Cited by 119 publications

(57 citation statements)

References 9 publications

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“…Approximately 1:200 fetuses with atrial ectopy are at risk for the development of SVT in utero or at up to 1 month of age. 11 Frequent ectopy was present in 4 of our subjects and could be distinguished as reentrant PACs versus spontaneous multifocal atrial activations on the basis of single atrial morphology and short, fixed coupling interval.…”

Section: Discussionmentioning

confidence: 84%

Magnetocardiographic Rhythm Patterns at Initiation and Termination of Fetal Supraventricular Tachycardia

et al. 2003

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Background-Using fetal magnetocardiography (fMCG), we characterize for the first time the electrophysiological patterns of initiation and termination of reentrant fetal supraventricular tachycardia (SVT), the most common form of life-threatening fetal arrhythmia. Methods and Results-In contrast to the expectation that reentrant SVT is initiated by spontaneous premature atrial contractions (PACs) and is terminated by spontaneous block, 5 distinct patterns of initiation and 4 patterns of termination were documented, with the most common patterns of initiation involving reentrant PACs. Waveform morphology and timing, including QRS and ventriculoatrial interval, were assessed. This enabled detection of such phenomena as Wolff-Parkinson-White syndrome, QRS aberrancy, and multiple reentrant pathways that were crucial for defining the rhythm patterns. In addition, fMCG actocardiography revealed an unexpectedly strong association between fetal trunk movement and the initiation and termination of SVT, suggesting that autonomic influences play a key role. Conclusions-This study demonstrates that the patterns of initiation and termination of fetal SVT are more diverse than is generally believed and that the most common patterns of initiation involve reentrant PACs. The ability to discern such patterns can help elucidate the underlying mechanisms and guide antiarrhythmic drug therapy. fMCG provides a noninvasive means of analyzing complex tachyarrhythmia in utero, with efficacy approaching that of postnatal electrocardiographic rhythm monitoring.

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Section: Discussionmentioning

confidence: 84%

Magnetocardiographic Rhythm Patterns at Initiation and Termination of Fetal Supraventricular Tachycardia

et al. 2003

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“…Fetal echocardiography to ascertain mechanism of bradycardia, and if persistent, monitoring to assess heart rate, rhythm and cardiac function Irregular rhythm 66 0.3% with CHD; 2% with arrhythmia (0-0.7) I/C (frequent) IIa/C (persistent > 1-2 wks)…”

Section: -55 I/c At Detectionmentioning

confidence: 99%

“…66 Because premature atrial contractions may be difficult to distinguish from premature ventricular contractions and other types of more significant arrhythmias, fetuses with frequent ectopic beats (bigeminy, trigeminy, or more than every 3-5 beats on average) should have a baseline fetal echocardiogram to assess cardiac structure and function and to determine the mechanism of the arrhythmia (discussed in the Irregular Rhythm section). In fetuses with less frequent extrasystoles, if there is any question about the mechanism, if the ectopic beats persist beyond 1 to 2 weeks, or if the practitioner lacks sufficient training or experience to differentiate a benign irregular rhythm from a pathological one, a fetal echocardiogram is reasonable to perform.…”

Section: Suspected Abnormality Of Heart Rate or Rhythmmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

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925

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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“…13,14,16 Also, the indication of fetal arrhythmia has a low risk for structural cardiac defects; therefore, routine referral for FE will yield very little additional information after normal FAU findings. 17,18 Fetal echocardiography for other indications, such as teratogen exposure and echogenicity in the fetal heart, will continue Echocardiography After Detailed Fetal Anatomic Ultrasonography to have a low yield in finding a major CHD that is not detected by FAU. 9,19 Therefore, as confirmed in other studies, FE may be reserved primarily for patients with abnormal cardiac findings during FAU.…”

Section: Discussionmentioning

confidence: 99%

Utility of Fetal Echocardiography After Normal Cardiac Imaging Findings on Detailed Fetal Anatomic Ultrasonography

Starikov

Bsat

Knee

et al. 2009

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to assess the utility of fetal echocardiography (FE) after normal fetal cardiac imaging findings during detailed fetal anatomic ultrasonography (FAU). Methods. We conducted a retrospective cohort review of obstetric ultrasonographic studies from November 2001 through July 2005. We identified women with a singleton gestation with increased risk for congenital heart disease who received FAU performed by a maternal-fetal medicine specialist at 16 to 20 weeks' gestation with subsequent FE. These records were compared with newborn outcomes. Results. Of 789 pregnancies that had FAU and FE, 481 had satisfactory cardiac imaging. Of those, only 1 fetus had abnormal FE findings. After delivery, 4 of the 480 neonates with normal FAU and FE findings had a diagnosis of a heart defect. Conclusions. Fetal echocardiography does not substantially increase the detection rate of major cardiac anomalies after normal findings on detailed FAU performed by a maternal-fetal medicine specialist.

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The clinical significance of the irregular fetal heart rhythm

Cited by 119 publications

References 9 publications

Magnetocardiographic Rhythm Patterns at Initiation and Termination of Fetal Supraventricular Tachycardia

Magnetocardiographic Rhythm Patterns at Initiation and Termination of Fetal Supraventricular Tachycardia

Diagnosis and Treatment of Fetal Cardiac Disease

Utility of Fetal Echocardiography After Normal Cardiac Imaging Findings on Detailed Fetal Anatomic Ultrasonography

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