Fetal Bradyarrhythmia Associated With Congenital Heart Defects　– Nationwide Survey in Japan –

Takekazu Miyoshi; Yasuki Maeno; Haruhiko Sago; Noboru Inamura; Satoshi Yasukouchi; Motoyoshi Kawataki; Hitoshi Horigome; Hitoshi Yoda; Mio Taketazu; Makio Shozu; Masaki Nii; Hitoshi Kato; Akiko Hagiwara; Akiko Omoto; Wataru Shimizu; Isao Shiraishi; Heima Sakaguchi; Kunihiro Nishimura; Michikazu Nakai; Keiko Ueda; Shinji Katsuragi; Tomoaki Ikeda

doi:10.1253/circj.CJ-14-0978

Pediatric Cardiology and Adult Congenital Heart Disease

Fetal Bradyarrhythmia Associated With Congenital Heart Defects　– Nationwide Survey in Japan –

Takekazu Miyoshi, Yasuki Maeno, Haruhiko Sago, Noboru Inamura, Satoshi Yasukouchi, Motoyoshi Kawataki, Hitoshi Horigome, Hitoshi Yoda, Mio Taketazu, Makio Shozu, Masaki Nii, Hitoshi Kato, Akiko Hagiwara, Akiko Omoto, Wataru Shimizu, Isao Shiraishi, Heima Sakaguchi, Kunihiro Nishimura, Michikazu Nakai, Keiko Ueda, Shinji Katsuragi, Tomoaki Ikeda

Author information

Takekazu Miyoshi
National Cerebral and Cardiovascular Center
Yasuki Maeno
Kurume University School of Medicine
Haruhiko Sago
National Center for Child Health and Development
Noboru Inamura
Osaka Medical Center and Research Institute for Maternal and Child Health
Satoshi Yasukouchi
Nagano Children’s Hospital
Motoyoshi Kawataki
Kanagawa Children’s Medical Center
Hitoshi Horigome
University of Tsukuba
Hitoshi Yoda
Toho University Omori Medical Center
Mio Taketazu
Saitama Medical University International Medical Center
Makio Shozu
Chiba University
Masaki Nii
Shizuoka Children’s Hospital
Hitoshi Kato
National Center for Child Health and Development
Akiko Hagiwara
Kanagawa Children’s Medical Center
Akiko Omoto
Chiba University
Wataru Shimizu
Nippon Medical School
Isao Shiraishi
National Cerebral and Cardiovascular Center
Heima Sakaguchi
National Cerebral and Cardiovascular Center
Kunihiro Nishimura
National Cerebral and Cardiovascular Center
Michikazu Nakai
National Cerebral and Cardiovascular Center
Keiko Ueda
National Cerebral and Cardiovascular Center
Shinji Katsuragi
National Cerebral and Cardiovascular Center
Tomoaki Ikeda
Mie University

Keywords: Atrioventricular block, Bradyarrhythmia, Congenital heart defects, Fetus, Left atrial isomerism

JOURNAL FREE ACCESS FULL-TEXT HTML

2015 Volume 79 Issue 4 Pages 854-861

DOI https://doi.org/10.1253/circj.CJ-14-0978

Editorial (79-4 pp.761-762)

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Abstract

Background:Because there is limited information on fetal bradyarrhythmia associated with congenital heart defects (CHD), we investigated its prognosis and risk factors.Methods and Results:In our previous nationwide survey of fetal bradyarrhythmia from 2002 to 2008, 38 fetuses had associated CHD. Detailed clinical data were collected from secondary questionnaires on 29 fetuses from 18 institutions, and were analyzed. The 29 fetuses included 22 with isomerism, 4 with corrected transposition of the great arteries (TGA) and 3 with critical pulmonary stenosis; 14 had complete atrioventricular block (AVB), 8 had second-degree AVB, and 16 had sick sinus syndrome; 5 died before birth, and 10 died after birth (5 in the neonatal period). Neonatal and overall survival rates for fetal bradyarrhythmia with CHD were 66% and 48%, respectively. Pacemaker implantation was needed in 17 cases (89%). Beta-sympathomimetics were administered in utero in 13 cases and were effective in 6, but were not associated with prognosis. All cases of corrected TGA or ventricular rate ≥70 beats/min survived. A ventricular rate <55 beats/min had significant effects on fetal myocardial dysfunction (P=0.02) and fetal hydrops (P=0.04), resulting in high mortality.Conclusions:The prognosis of fetal bradyarrhythmia with CHD is still poor. The type of CHD, fetal myocardial dysfunction, and fetal hydrops were associated with a poor prognosis, depending on the ventricular rate. (Circ J 2015; 79: 854–861)

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