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Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias

Published online by Cambridge University Press:  18 August 2009

Rajka Lulić Jurjević ,
Tomaž Podnar  and
Samo Vesel
Rajka Lulić Jurjević
Affiliation:
Cardiology Unit, Children’s Hospital Srebrnjak, Zagreb, Croatia
Tomaž Podnar
Affiliation:
Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Ljubljana, Slovenia
Samo Vesel*
Affiliation:
Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Ljubljana, Slovenia
*
Correspondence to: Dr Samo Vesel, Department of Paediatrics, Cardiology Unit, University Medical Centre Ljubljana, Bohoriceva 20, SI-1000 Ljubljana, Slovenia. Tel: +386 1 522 9332; Fax: +386 1 522 9357; E-mail: samo.vesel@mf.uni-lj.si
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Abstract

Objective

To evaluate the diagnosis, clinical features, management and post-natal follow-up in consecutive fetuses identified with tachycardia.

Methods

We reviewed consecutive fetuses with tachycardia identified in a single tertiary institution between January, 2001, and December, 2008. We considered several options for management, including no treatment but close surveillance, trans-placental antiarrhythmic therapy in fetuses presenting prior to 36 weeks of gestation, and delivery and treatment as a neonate for fetuses presenting after 36 weeks of gestation. Data was gathered by a review of prenatal and postnatal documentation.

Results

Among 29 fetuses with tachycardia, 21 had supraventricular tachycardia with 1 to 1 conduction, 4 had atrial flutter, 3 had atrial tachycardia, while the remaining fetus had ventricular tachycardia. Of the group, 8 fetuses (27.6%) were hydropic. Transplacental administration of antiarrhythmic drugs was used in just over half the fetuses, delivery and treatment as a neonate in one-quarter, and no intervention but close surveillance in one-sixth of the case. Twenty-six of 29 fetuses (89.7%) were born alive. Only patients with fetal hydrops suffered mortality, with 37.5% of this group dying, this being statistically significant, with the value of p equal to 0.03, when compared to non-hydropic fetuses. Only 3 patients (11.5%) were receiving antiarrhythmic prophylaxis beyond the first year of life.

Conclusion

A significant proportion of fetal tachycardias recognized before 36 weeks of gestation can be treated successfully by transplacental administration of antiarrhythmic drugs. Fetuses presenting after 36 weeks of gestation can be effectively managed postnatally. The long-term prognosis for fetuses diagnosed with tachycardia is excellent, with the abnormal rhythm resolving spontaneously during the first year of life in most of them.

Keywords

Fetal medicinearrhythmiaoutcome
Type
Original Article
Information
Cardiology in the Young , Volume 19 , Issue 5 , October 2009 , pp. 486 - 493
Copyright
Copyright © Cambridge University Press 2009

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