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  • Review Article
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Fetal cardiac arrhythmia detection and in utero therapy

Nature Reviews Cardiology volume 7, pages 277–290 (2010)Cite this article

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Abstract

The human fetal heart develops arrhythmias and conduction disturbances in response to ischemia, inflammation, electrolyte disturbances, altered load states, structural defects, inherited genetic conditions, and many other causes. Yet sinus rhythm is present without altered rate or rhythm in some of the most serious electrophysiological diseases, which makes detection of diseases of the fetal conduction system challenging in the absence of magnetocardiographic or electrocardiographic recording techniques. Life-threatening changes in QRS or QT intervals can be completely unrecognized if heart rate is the only feature to be altered. For many fetal arrhythmias, echocardiography alone can assess important clinical parameters for diagnosis. Appropriate treatment of the fetus requires awareness of arrhythmia characteristics, mechanisms, and potential associations. Criteria to define fetal bradycardia specific to gestational age are now available and may allow detection of ion channelopathies, which are associated with fetal and neonatal bradycardia. Ectopic beats, once thought to be entirely benign, are now recognized to have important pathologic associations. Fetal tachyarrhythmias can now be defined precisely for mechanism-specific therapy and for subsequent monitoring of response. This article reviews the current and future diagnostic techniques and pharmacologic treatments for fetal arrhythmia.

Key Points

  • Fetal demise related to cardiac depolarization or repolarization abnormalities may be preventable

  • Genetic ion channel diseases often present with fetal bradycardia

  • The prognosis of patients with complete atrioventricular block depends on the etiology of this condition

  • Fetal magnetocardiography enhances diagnosis and treatment

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Figure 1: Two fetal magnetocardiography recordings from a 30-week fetus with long QT syndrome 3.1
Figure 2: Signal-averaged electrograms of fetal magnetocardiography recordings from a fetus with maternal SSA/Ro autoantibody isoimmunization.
Figure 3: Simultaneous fetal magnetocardiography and Doppler echocardiography recordings from a fetus with isoimmune third-degree atrioventricular block at 23 weeks and 4 days of gestation.
Figure 4: Combined fetal magnetocardiography and Doppler echocardiography tracing from a fetus with atrial ectopic tachycardia and intermittent atrioventricular block (during tachycardia) at 25 weeks and 5 days of gestation.
Figure 5: Fetal magnetocardiography and Doppler echocardiography tracings from a fetus with a rhythm pattern that simulated Mobitz type I second-degree atrioventricular block at 18 weeks and 1 day of gestation.

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Acknowledgements

Ours is team science. We acknowledge Nana Aba Mensah Brown, Suhong Yu, Hui Zhao, Zhimin Li, Zhen Ji, Medical Physics graduate students U. W. Madison who processed the data, William Lutter, Medical Physicist who supported the technology infrastructure, Gretchen Eckstein, research obstetrics nurse, Bageshree Cheulkar, research assistant to Dr Strasburger, Bettina Cuneo, interpretation and patient management, and the pediatric cardiologists and maternal fetal medicine specialists who supported this research through their referrals. Grant support includes NIH R01HL63174, R21HD049022, R42HL092755, R44HL082017, R43HD055091, and the Advancing a Healthier Wisconsin Fund. Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. Division of Pediatric Cardiology, Department of Pediatrics, Children's Hospital of Wisconsin, 9000 W. Wisconsin Avenue, Milwaukee, 53226, WI, USA

    Janette F. Strasburger

  2. Department of Medical Physics, 1163 Wisconsin Institutes for Medical Research, University of Wisconsin–Madison, 1111 Highland Avenue, Madison, 53705, WI, USA

    Ronald T. Wakai

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  1. Janette F. Strasburger
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  2. Ronald T. Wakai
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Correspondence to Janette F. Strasburger.

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Supplementary information

Supplementary Figure 1

Fetal magnetocardiography recordings from a 26-week fetus (PDF 102 kb)

Supplementary Figure 2

Fetal magnetocardiography and Doppler echocardiography tracings from a 29-week fetus with re-entrant supraventricular tachycardia (PDF 195 kb)

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Strasburger, J., Wakai, R. Fetal cardiac arrhythmia detection and in utero therapy. Nat Rev Cardiol 7, 277–290 (2010). https://doi.org/10.1038/nrcardio.2010.32

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