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Pediatric Cardiology

, Volume 34, Issue 1, pp 81–87 | Cite as

Postnatal Outcome in Patients With Fetal Tachycardia

  • Shreya Moodley
  • Shubhayan SanataniEmail author
  • James E. Potts
  • George G. S. Sandor
Original Article

Abstract

The diagnosis and management of prenatal tachyarrhythmias is well established; however, the postnatal course and outcomes are not. The purpose of our study was to review the natural history of patients with fetal tachycardia, determine the incidence of postnatal arrhythmias, and determine whether there are factors to predict which fetuses will develop postnatal arrhythmias. A retrospective chart review of patients with fetal tachyarrhythmias investigated at British Columbia Children’s and Women’s Hospitals between 1983 and 2010 was conducted. Sixty-nine mother–fetus pairs were eligible for the study. Fifty-two had fetal supraventricular tachycardia, and 17 had fetal atrial flutter. Conversion to sinus rhythm occurred prenatally in 52 % of patients. Postnatal arrhythmia occurred in two thirds of patients, with 82 % of those cases occurring within the first 48 h of life. Hydrops fetalis, female sex, and lack of conversion to sinus rhythm was predictive of postnatal arrhythmia (P = 0.01, P = 0.01, and P = 0.001, respectively). Conversion to sinus rhythm prenatally did not predict postnatal arrhythmia. Median duration of treatment was 9 months. Two postnatal deaths of unknown etiology occurred. Two thirds of all patients with prenatal tachycardia will develop postnatal arrhythmia. Prenatal factors that predict postnatal arrhythmia include hydrops, sex, and whether or not conversion to sinus rhythm occurred prenatally. The majority of patients with postnatal arrhythmia present within 48 h of life, which has clinical implications for monitoring. Postnatal outcome is generally very good with most patients being weaned off medication in 6–12 months.

Keywords

Atrial flutter Natural history Prenatal and postnatal arrhythmias Supraventricular tachycardia 

References

  1. 1.
    Api O, Carvalho JS (2008) Fetal dysrhythmias. Best practice and research. Clin Obstet Gynaecol 22:31–48Google Scholar
  2. 2.
    Bauersfeld U, Pfammatter JP, Jaeggi E (2001) Treatment of supraventricular tachycardias in the new millenium—drugs or radio-frequency catheter ablation? Eur J Pediatr 160:1–9PubMedCrossRefGoogle Scholar
  3. 3.
    Boldt T, Eronen M, Andersson S (2003) Long-term outcome in fetuses with cardiac arrhythmias. Obstet Gynecol 102:1372–1379PubMedCrossRefGoogle Scholar
  4. 4.
    Cornette J, Ten Harkel ADJ, Steegers EAP (2009) Fetal dilated cardiomyopathy caused by PJRT. Ultrasound Obstet Gynecol 33:595–598PubMedCrossRefGoogle Scholar
  5. 5.
    D’Alto M, Russo MG, Paladini D, Di Salvo G, Romeo E, Ricci C et al (2008) The challenge of fetal dysrhythmias: echocardiographic diagnosis and clinical management. J Cardiovasc Med 9:153–160CrossRefGoogle Scholar
  6. 6.
    Darragh R (1999) Fetal tachycardias. ACC Curr J Rev 8:63–66CrossRefGoogle Scholar
  7. 7.
    Hahurij ND, Gittenberger-De Groot AC, Kolditz DP, Bokenkamp R, Schalij MJ, Poelmann RE et al (2008) Accessory atrioventricular myocardial connections in the developing human heart: relevance for perinatal SVT. Circulation 117:2850–2858PubMedCrossRefGoogle Scholar
  8. 8.
    Hornberger LK, Sahn DJ (2007) Rhythm abnormalities of the fetus. Heart 93:1294–1300PubMedCrossRefGoogle Scholar
  9. 9.
    Jaeggi E, Fouron JC, Drblik SP (1998) Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome. J Pediatr 132:335–339PubMedCrossRefGoogle Scholar
  10. 10.
    Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur S-AB, Rammeloo L et al (2011) Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized center study. Circulation 124:1474–1754CrossRefGoogle Scholar
  11. 11.
    Krapp M, Kohl T, Simpon JM, Sharland GK, Katalinic A, Gembruch U (2003) Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with SVT. Heart 89:913–917PubMedCrossRefGoogle Scholar
  12. 12.
    Lulic Jurjevic R, Podnar T, Vesel S (2009) Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias. Cardiol Young 19:486–493PubMedCrossRefGoogle Scholar
  13. 13.
    Maeno Y, Hirose A, Kanbe T, Hori D (2009) Fetal arrhythmia: prenatal diagnosis and perinatal management. J Obstet Gynaecol Res 35:623–629PubMedCrossRefGoogle Scholar
  14. 14.
    Mongiovi M, Pipitone S (2008) Supraventricular tachycardia in fetus: how can we treat? Curr Pharm Des 14:736–742PubMedCrossRefGoogle Scholar
  15. 15.
    Oudijk MA, Michon MM, Kleinman CS, Kapusta L, Stoutenbeek P, Visser GH et al (2000) Sotalol in the treatment of fetal dysrhythmias. Circulation 101:2721–2726PubMedCrossRefGoogle Scholar
  16. 16.
    Pezard PG, Boussion F, Sentilhes L, Lepinard C, Couvreur M-H, Victor J et al (2008) Fetal tachycardia: a role for amiodarone as first- or second-line therapy? Arch Cardiovasc Dis 101:619–627PubMedCrossRefGoogle Scholar
  17. 17.
    Simpson LL (2000) Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol 24:360–372PubMedCrossRefGoogle Scholar
  18. 18.
    Simpson JM (2006) Fetal arrhythmias. Ultrasound Obstet Gynecol 27:599–606PubMedCrossRefGoogle Scholar
  19. 19.
    Simpson JM, Sharland GK (1998) Fetal tachycardia: management and outcome of 127 consecutive cases. Heart 79:576–581PubMedGoogle Scholar
  20. 20.
    Singh GK (2004) Management of fetal tachyarrhythmias. Curr Treat Options Cardiovasc Med 6:399–406PubMedCrossRefGoogle Scholar
  21. 21.
    Skinner JR, Sharland G (2008) Detection and management of life-threatening arrhythmias in the perinatal period. Early Hum Dev 84:161–172PubMedCrossRefGoogle Scholar
  22. 22.
    Srinivasan S, Strasburger J (2008) Overview of fetal arrhythmias. Curr Opin Pediatr 20:522–531PubMedCrossRefGoogle Scholar
  23. 23.
    Strasburger JF (2005) Prenatal diagnosis of fetal arrhythmias. Clin Perinatol 32:891–912PubMedCrossRefGoogle Scholar
  24. 24.
    Trappe H-J (2006) Acute therapy of maternal and fetal arrhythmias during pregnancy. J Intensive Care Med 21:305PubMedCrossRefGoogle Scholar
  25. 25.
    Vaksmann G, D’ Hoinne C, Lucet V, Guillaumont S, Lupoglazoff J-M, Chantepie A et al (2006) Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome. Heart 92:101–104PubMedCrossRefGoogle Scholar
  26. 26.
    van Engelen AD, Weijtens O, Brenner JI, Kleinman CS, Copel JA, Stoutenbeek P et al (1994) Management, outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 24:1371–1375PubMedCrossRefGoogle Scholar
  27. 27.
    Vergani P, Mariani E, Ciriello E, Locatelli A, Strobelt N, Galli M et al (2005) Fetal arrhythmias: natural history and management. Ultrasound Med Biol 31:1–6PubMedCrossRefGoogle Scholar
  28. 28.
    Wren C (2006) Cardiac arrhythmias in the fetus and newborn. Semin Fetal Neonatal Med 11:182–190PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Shreya Moodley
    • 1
  • Shubhayan Sanatani
    • 1
    Email author
  • James E. Potts
    • 1
  • George G. S. Sandor
    • 1
  1. 1.Division of Pediatric CardiologyBritish Columbia Children’s Hospital and The University of British ColumbiaVancouverCanada

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