Perinatal management and long-term cardiac outcome in fetal arrhythmia
Nathan D. Hahurij
, Nico A. Blom
, Enrico Lopriore
, Mohammad I. Aziz
, Helene T. Nagel
, Frank P.H.A. Vandenbussche
Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
Department of Obstetrics and Gynecology, Bronovo Hospital, The Hague, The Netherlands
Received 24 August 2010
Accepted 2 November 2010
Background: Cardiac arrhythmias are commonly observed in the fetus, however, may have major
consequences for fetal development and post natal life.
Aims: To evaluate the perinatal management and cardiac outcome of fetuses with tachy- or bradyarrhythmia.
Study design: Perinatal management, outcome and long-term cardiac follow-up were evaluated retrospec-
tively in consecutive fetuses with cardiac arrhythmias.
Results: Forty-four fetuses were diagnosed: supraventricular tachycardia (SVT, n=28), atrial ﬂutter (AF,
n=7) and atrioventricular block (AVB, n = 9). The overall incidence of cardiac anomalies was 18% mainly in
the AVB group; hydrops was present in 34%. Direct or transplacental fetal anti-arrhythmic medication was
given in 76%. Mortality was 6% in SVT/AF and 78% in the AVB group, respectively. AF resolved in all patients. In
the SVT group, Wolff–Parkinson–White (WPW) syndrome was present in 21%, diagnosed at birth or later in
life. After the age of one year about 90% of patients in the SVT group remained asymptomatic and free of drugs
(median follow-up 76 months).
Conclusions: Mortality rate is low in patients with fetal SVT and AF but high in patients with AVB. Related
morbidity includes WPW-syndrome and congenital cardiac anomalies. Electrocardiographic screening is
recommended in all fetal SVT cases before adolescence since WPW-syndrome may occur later in life.
© 2010 Elsevier Ireland Ltd. All rights reserved.
Fetal arrhythmias are common in clinical practice with a frequency
ranging from 1% to 3% of all pregnancies. Most of these arrhythmias
reﬂect transient, isolated atrial ectopic beats. However, sustained
episodes of tachy- or bradyarrhythmia do occur and can lead to
congestive heart failure, hydrops, fetal or neonatal demise, or severe
neurologic morbidity in survivors [1–7].
The most common forms of fetal tachycardias are supraventricular
tachycardia (SVT) and atrial ﬂutter (AF). The majority of fetal SVTs are
atrioventricular re-entrant tachycardias (AVRT) caused by the
presence of an accessory atrioventricular myocardial pathway .If
indicated, anti-arrhythmic drugs can be given transplacentally or
directly to the fetus. In SVT and AF, various anti-arrhythmic drugs are
used, including digoxin, ﬂecainide, sotalol and amiodarone .
More than three quarters of fetal bradycardia cases are caused by
complete atrioventricular block (AVB). AVB in the absence of
structural heart disease is mostly autoimmune mediated by maternal
anti-Ro (SS-A) or anti-La (SS-B) antibodies . In AVB, transplacental
steroid treatment may reduce the effects of inﬂammation and ﬁbrosis
of the conduction system caused by maternal antibodies .
Complete AVB in the presence of complex congenital heart disease
(CHD) has a poor prognosis [12,13].
Elective delivery by cesarean section can be performed in the third
trimester of pregnancy to start direct neonatal therapy (anti-
arrhythmic drugs, radiofrequency catheter ablation or pacemaker
therapy). The goal of pre- and postnatal treatment of tachycardia is to
achieve sinus rhythm or to reduce the fetal heart rate in order to
prevent heart failure or death. In most cases of fetal tachycardia,
medication can be stopped within the ﬁrst year after delivery.
However, in cases of fetal and neonatal SVT recurrences can be
expected in approximately 30% of patients later in life .
The aim of this study was to evaluate the perinatal management
and long-term cardiologic outcome of fetuses with tachy- or
bradyarrhythmia diagnosed at our center.
2. Material and methods
We searched both our antenatal and neonatal databases for infants
with in utero cardiac arrhythmia, diagnosed between January 1990
Early Human Development 87 (2011) 83–87
⁎ Corresponding author. Leiden University Medical Center, PO Box 9600, 2300 RC,
Leiden, The Netherlands.
E-mail address: N.A.Blom@lumc.nl (N.A. Blom).
0378-3782/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
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