Fetal Cardiac Arrhythmias (Content last reviewed: 15th March 2020)

Christoph Wohlmuth; Helena M. Gardiner

Chapter 14 - Fetal Cardiac Arrhythmias (Content last reviewed: 15th March 2020)

from Section 3 - Late Prenatal – Fetal Problems

Published online by Cambridge University Press: 15 November 2017

Christoph Wohlmuth and

Edited by

Bernard Gonik and

David James: Affiliation:
University of Nottingham
Philip Steer: Affiliation:
Imperial College London
Carl Weiner: Affiliation:
University of Kansas
Bernard Gonik: Affiliation:
Wayne State University, Detroit
Stephen Robson: Affiliation:
University of Newcastle

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Summary

The myocardium first starts to contract about 26 days after conception as a consequence of the rhythmical electrical depolarization of pacemaker-precursor cells. Cardiac arrhythmias are commonly encountered later in development and have been reported in about 2% of all pregnancies. With increasing use of antenatal screening, arrhythmias are more likely to be encountered, usually as a random pick-up. While the majority of them are benign (mostly atrial ectopic beats), some are associated with significant morbidity and mortality. For the latter group appropriate antenatal diagnosis may improve outcome by proper pre- and postnatal therapy.

Type: Chapter
Information: High-Risk Pregnancy
Management Options
, pp. 321 - 339

DOI: https://doi.org/10.1017/9781108349185 [Opens in a new window]

Publisher: Cambridge University Press

First published in: 2017

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References

Wisser, J, Dirschedl, P. Embryonic heart rate in dated human embryos. Early Hum Dev 1994; 37: 107–15.Google Scholar

Southall, DP, Richards, J, Hardwick, RA, et al. Prospective study of fetal heart rate and rhythm patterns. Arch Dis Child 1980; 55: 506–11.Google Scholar

Reed, KL. Fetal arrhythmias: etiology, diagnosis, pathophysiology, and treatment. Semin Perinatol 1989; 13: 294–304.Google Scholar

Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129: 2183–242.Google Scholar

Schmidt, KG, Ulmer, HE, Silverman, NH, Kleinman, CS, Copel, JA. Perinatal outcome of fetal complete atrioventricular block: a multicenter experience. J Am Coll Cardiol 1991; 17: 1360–6.Google Scholar

Strasburger, JF, Huhta, JC, Carpenter, RJ, Garson, A, McNamara, DG. Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias. J Am Coll Cardiol 1986; 7: 1386–91.Google Scholar

Nii, M, Hamilton, RM, Fenwick, L, et al. Assessment of fetal atrioventricular time intervals by tissue Doppler and pulse Doppler echocardiography: normal values and correlation with fetal electrocardiography. Heart 2006; 92: 1831–7.Google Scholar

Carvalho, JS, Prefumo, F, Ciardelli, V, et al. Evaluation of fetal arrhythmias from simultaneous pulsed wave Doppler in pulmonary artery and vein. Heart 2007; 93: 1448–53.Google Scholar

Berg, C, Geipel, A, Gembruch, U. Spectral Doppler imaging of the renal vessels facilitates the assessment of fetal arrhythmias. Ultrasound Obstet Gynecol 2009; 33: 367–8.Google Scholar

Rein, AJJT, O’Donnell, C, Geva, T, et al. Use of tissue velocity imaging in the diagnosis of fetal cardiac arrhythmias. Circulation 2002; 106: 1827–33.Google Scholar

Taylor, MJO, Smith, MJ, Thomas, M, et al. Non-invasive fetal electrocardiography in singleton and multiple pregnancies. BJOG 2003; 110: 668–78.Google Scholar

Pasquini, L, Seale, AN, Belmar, C, et al. PR interval: a comparison of electrical and mechanical methods in the fetus. Early Hum Dev 2007; 83: 231–7.Google Scholar

Strasburger, JF, Cheulkar, B, Wakai, RT. Magnetocardiography for fetal arrhythmias. Heart Rhythm 2008; 5: 1073–6.Google Scholar

Van Hare, GF. Magnetocardiography in the diagnosis of fetal arrhythmias. Heart Rhythm 2013; 10: 1199–200.Google Scholar

American College of Cardiology Foundation, American Heart Association. Methodology Manual and Policies from the ACCF/AHA Task Force on Practice Guidelines, 2010. http://assets.cardiosource.com/Methodology_Manual_for_ACC_AHA_Writing_Committees.pdf (accessed March 2017).Google Scholar

Simpson, JM, Yates, RW, Sharland, GK. Irregular heart rate in the fetus: not always benign. Cardiol Young 2008; 6: 28–31.Google Scholar

Api, O, Carvalho, JS. Fetal dysrhythmias. Best Pract Res Clin Obstet Gynaecol 2008; 22: 31–48.Google Scholar

Van Engelen, AD, Weijtens, O, Brenner, JI, et al. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 1994; 24: 1371–5.Google Scholar

Skinner, JR, Sharland, G. Detection and management of life threatening arrhythmias in the perinatal period. Early Hum Dev 2008; 84: 161–72.Google Scholar

Jaeggi, ET, Nii, M. Fetal brady- and tachyarrhythmias: new and accepted diagnostic and treatment methods. Semin Fetal Neonatal Med 2005; 10: 504–14.Google Scholar

Maxwell, DJ, Crawford, DC, Curry, PV, Tynan, MJ, Allan, LD. Obstetric importance, diagnosis, and management of fetal tachycardias. BMJ 1988; 297: 107–10.Google Scholar

Jaeggi, ET, Carvalho, JS, De Groot, E, et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124: 1747–54.Google Scholar

Mangione, R, Guyon, F, Vergnaud, A, et al. Successful treatment of refractory supraventricular tachycardia by repeat intravascular injection of amiodarone in a fetus with hydrops. Eur J Obstet Gynecol Reprod Biol 1999; 86: 105–7.Google Scholar

Krapp, M, Kohl, T, Simpson, JM, et al. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 2003; 89: 913–17.Google Scholar

Shah, A, Moon-Grady, A, Bhogal, N, Collins, KK, Tacy, T, Brook, M, Hornberger, LK. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol 2012; 109: 1614–18.Google Scholar

Hahurij, ND, Blom, NA, Lopriore, E, et al. Perinatal management and long-term cardiac outcome in fetal arrhythmia. Early Hum Dev 2011; 87: 83–7.Google Scholar

Jaeggi, E, Fouron, JC, Drblik, SP. Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome. J Pediatr 1998; 132: 335–9.Google Scholar

Wladimiroff, JW, Stewart, PA, Tonge, HM. Fetal bradyarrhythmia: diagnosis and outcome. Prenat Diagn 1988; 8: 53–7.Google Scholar

Ho, SY, Fagg, N, Anderson, RH, Cook, A, Allan, L. Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block. J Am Coll Cardiol 1992; 20: 904–10.Google Scholar

Brucato, A, Frassi, M, Franceschini, F, et al. Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counter immunoelectrophoresis: a prospective study of 100 women. Arthritis Rheum 2001; 44: 1832–5.Google Scholar

Friedman, DM, Kim, MY, Copel, JA, et al. Utility of cardiac monitoring in fetuses at risk for congenital heart block: the PR Interval and Dexamethasone Evaluation (PRIDE) prospective study. Circulation 2008; 117: 485–93.Google Scholar

Taylor, P V, Scott, JS, Gerlis, LM, Esscher, E, Scott, O. Maternal antibodies against fetal cardiac antigens in congenital complete heart block. N Engl J Med 1986; 315: 667–72.Google Scholar

Ho, SY, Esscher, E, Anderson, RH, Michaëlsson, M. Anatomy of congenital complete heart block and relation to maternal anti-Ro antibodies. Am J Cardiol 1986; 58: 291–4.Google Scholar

Sonesson, SE, Salomonsson, S, Jacobsson, LA, Bremme, K, Wahren-Herlenius, M. Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies. Arthritis Rheum 2004; 50: 1253–61.Google Scholar

Breur, JMPJ, Visser, GHA, Kruize, AA, Stoutenbeek, P, Meijboom, EJ. Treatment of fetal heart block with maternal steroid therapy: case report and review of the literature. Ultrasound Obstet Gynecol 2004; 24: 467–72.Google Scholar

Jaeggi, ET, Fouron, JC, Silverman, ED, et al. Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation 2004; 110: 1542–8.Google Scholar

Eliasson, H, Sonesson, SE, Sharland, G, et al. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation 2011; 124: 1919–26.Google Scholar

Friedman, DM, Kim, MY, Copel, JA, et al. Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol 2009; 103: 1102–6.Google Scholar

Cuneo, BF, Zhao, H, Strasburger, JF, et al. Atrial and ventricular rate response and patterns of heart rate acceleration during maternal-fetal terbutaline treatment of fetal complete heart block. Am J Cardiol 2007; 100: 661–5.Google Scholar

Hutter, D, Silverman, ED, Jaeggi, ET. The benefits of transplacental treatment of isolated congenital complete heart block associated with maternal anti-Ro/SSA antibodies: a review. Scand J Immunol 2010; 72: 235–41.Google Scholar

Trucco, SM, Jaeggi, E, Cuneo, B, et al. Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol 2011; 57: 715–23.Google Scholar

Zhou, L, Chmait, R, Bar-Cohen, Y, Peck, RA, Loeb, GE. Percutaneously injectable fetal pacemaker: electrodes, mechanical design and implantation. Conf Proc Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Conf 2012; 2012: 6600–3.Google Scholar

Loeb, GE, Zhou, L, Zheng, K, et al. Design and testing of a percutaneously implantable fetal pacemaker. Ann Biomed Eng 2013; 41: 17–27.Google Scholar

Walkinshaw, SA, Welch, CR, McCormack, J, Walsh, K. In utero pacing for fetal congenital heart block. Fetal Diagn Ther 1994; 9: 183–5.Google Scholar

Carpenter, RJ, Strasburger, JF, Garson, A, Smith, RT, Deter, RL, Engelhardt, HT. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. J Am Coll Cardiol 1986; 8: 1434–6.Google Scholar

Moodley, S, Sanatani, S, Potts, JE, Sandor, GGS. Postnatal outcome in patients with fetal tachycardia. Pediatr Cardiol 2012; 34: 81–7.Google Scholar

Hornberger, LK, Sahn, DJ. Rhythm abnormalities of the fetus. Heart 2007; 93: 1294–300.Google Scholar

Jaeggi, ET, Hornberger, LK, Smallhorn, JF, Fouron, JC. Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol 2005; 26: 16–21.Google Scholar

Lopriore, E, Aziz, MI, Nagel, HT, et al. Long-term neurodevelopmental outcome after fetal arrhythmia. Am J Obstet Gynecol 2009; 201: 46.e1–5.Google Scholar

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Chapter 14 - Fetal Cardiac Arrhythmias (Content last reviewed: 15th March 2020)

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