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Erschienen in: Die Gynäkologie 1/2022

22.12.2021 | Tachykarde Herzrhythmusstörungen | Leitthema

Fetale Arrhythmien – ein Update

verfasst von: Prof. Dr. Ulrich Gembruch

Erschienen in: Die Gynäkologie | Ausgabe 1/2022

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Zusammenfassung

Länger anhaltende Arrhythmien werden bei 1–2 % der Feten nachgewiesen. Differenziert werden fetale Arrhythmien mittels M‑mode- und Doppler-Echokardiographie. Überwachung und Therapie sind der vorliegenden Arrhythmie anzupassen. Bei Tachyarrhythmien werden transplazentar Digoxin, Flecainid, Sotalol und Amiodaron eingesetzt, wobei Flecainid bei atrioventrikulären Reentry-Tachykardien mehr und mehr primär eingesetzt wird. Beim inflammatorisch bedingten kompletten AV(atrioventrikulären)-Block (congenital complete heart block, CCHB) durch maternale Anti-SSA/Ro-Antikörper ist eine generelle transplazentare Behandlung mit hochdosierten fluorierten Kortikosteroiden zur Eindämmung einer begleitenden Myokarditis aufgrund des Nebenwirkungsprofils nicht indiziert; sie ist allenfalls bei Feten mit Zeichen kardialer Dysfunktion und kardialer Fibrose zu erwägen. Zur Prävention sollte im Hochrisikokollektiv (Wiederholungsrisiko bei vorherigem Kind mit CCHB 16–19 %) die tägliche Gabe von 400 mg Hydroxychloroquin (HCQ) bereits vor der 10. Schwangerschaftswoche (SSW) erfolgen, wodurch das Risiko halbiert werden kann. Derzeit nicht indiziert ist eine generelle HCQ bei allen Schwangeren mit nachweisbaren Anti-SSA/Ro-Antikörpern zwecks Prävention, da aufgrund des geringen Risikos von 1–2 % die „number needed to treat“ (NNT) 100+ beträgt und relevante kardiale Ereignisse aufgrund der HCQ-bedingten QT-Zeit-Verlängerung möglich erscheinen. Die lange Zeit empfohlene sehr aufwendige wöchentlich echokardiographische Messung der fetalen AV-Zeit mit dem Ziel, einen AV-Block I. Grades zu erkennen und durch Behandlung mit Dexamethason das Auftreten einer CCHB zu verhindern, hat sich mittlerweile als ineffektiv erweisen.
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Metadaten
Titel
Fetale Arrhythmien – ein Update
verfasst von
Prof. Dr. Ulrich Gembruch
Publikationsdatum
22.12.2021
Verlag
Springer Medizin
Erschienen in
Die Gynäkologie / Ausgabe 1/2022
Print ISSN: 2731-7102
Elektronische ISSN: 2731-7110
DOI
https://doi.org/10.1007/s00129-021-04887-1

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