Fetal Arrhythmias

  • Trisha Vigneswaran
  • John SimpsonEmail author


Pathological heart rhythm disturbances in the fetus are uncommon, however, being able to correctly diagnose the type of arrhythmia and instigate the appropriate treatment is crucial for a good fetal outcome. In contrast to postnatal life, the diagnosis is usually made using ultrasound rather than electrocardiographic techniques. Tachycardias, bradycardias and irregular fetal heart rhythms are discussed including the approach to diagnosis and management.


Arrhythmia Fetus Fetal heart Bradycardia Tachycardia Ectopic beats Echocardiography 

Supplementary material

Video 11.1

Atrial extrasystoles (atrial ectopic beats) (MP4 3904 kb)

Video 11.2

Identification of supraventricular tachycardia using M Mode. The sample line is placed to ensure that it passes through atrial and ventricular tissue (MP4 2287 kb)

Video 11.3

Supraventricular tachycardia with hydrops. Bilateral pleural effusions are seen. The atrial and ventricular rates are identical on the M-mode (MP4 468 kb)

Video 11.4

Atrial flutter. The atrial rate is much faster than the ventricles (MP4 6016 kb)

Video 11.5

Fetus with ventricular tachycardia. The ventricular rate is faster than the atrial rate (MP4 338 kb)

Video 11.6

Demonstration of M mode to assess the atrial and ventricular rate simultaneously in the context of complete heart block. The M Mode cursor is aligned almost perpendicular to the atrial wall and the ventricle. The lower portion of the M-mode trace shows the regular atrial trace and the upper portion the slower ventricular rate (MP4 1397 kb)

Video 11.7

Complete heart block due to maternal anti-Ro antibodies. There is good ventricular function and no effusions are evident (MP4 1500 kb)

Video 11.8

Complete heart block due to maternal anti-Ro antibodies. This is seen in association with a pericardial effusion and widespread echogenicity of the heart at the crux, mitral valve and ventricular septum (MP4 1886 kb)


  1. American College of Obstetricians and Gynaecologists. ACOG Practice Bulletin No. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol. 2009;114:192–202.CrossRefGoogle Scholar
  2. Lopes LM, Tavares GM, Damiano AP, Lopes MA, Aiello VD, Schultz R, et al. Perinatal outcome of fetal atrioventricular block: one-hundred-sixteen cases from a single institution. Circulation. 2008;118(12):1268–75.CrossRefGoogle Scholar
  3. Carvalho JS, Prefumo F, Ciardelli V, Sairam S, Bhide A, Shinebourne EA. Evaluation of fetal arrhythmias from simultaneous pulsed wave Doppler in pulmonary artery and vein. Heart. 2007;93:1448–53.CrossRefGoogle Scholar
  4. Eliasson H, Sonesson SE, Sharland G, Granath F, Simpson JM, Carvalho JS, Jicinska H, Tomek V, Dangel J, Zielinsky P, Respondek-Liberska M, Freund MW, Mellander M, Bartrons J, Gardiner HM, Fetal Working Group of the European Association of Pediatric Cardiology. Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation. 2011;124:1919–26.CrossRefGoogle Scholar
  5. Friedman DM, Kim MY, Copel JA, Davis C, Phoon CK, Glickstein JS, Buyon JP, Pride Investigators. 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.CrossRefGoogle Scholar
  6. Ho A, Gordon P, Rosenthal E, Simpson J, Miller O, Sharland G. Isolated complete heart block in the fetus. Am J Cardiol. 2015;116:142–7.CrossRefGoogle Scholar
  7. Hunter LE, Simpson JM. Atrioventricular block during fetal life. J Saudi Heart Assoc. 2015;27:164–78.CrossRefGoogle Scholar
  8. Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, Mccrindle BW, Ryan G, Manlhiot C, Blom NA. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation. 2011;124:1747–54.CrossRefGoogle Scholar
  9. Jaeggi ET, Fouron JC, Silverman ED, Ryan G, Smallhorn J, Hornberger LK. Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation. 2004;110:1542–8.CrossRefGoogle Scholar
  10. Kan N, Silverman ED, Kingdom J, Dutil N, Laskin C, Jaeggi E. Serial echocardiography for immune-mediated heart disease in the fetus: results of a risk-based prospective surveillance strategy. Prenat Diagn. 2017;37(4):375–82.CrossRefGoogle Scholar
  11. Mitchell JL, Cuneo BF, Etheridge SP, Horigome H, Weng HY, Benson DW. Fetal heart rate predictors of long QT syndrome. Circulation. 2012;126:2688–95.CrossRefGoogle Scholar
  12. Nii M, Hamilton RM, Fenwick L, Kingdom JC, Roman KS, Jaeggi ET. 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.CrossRefGoogle Scholar
  13. Rosenthal E, Gordon PA, Simpson JM, Sharland GK. Letter regarding article by Jaeggi et al, “transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease”. Circulation. 2005;111:e287–8. author reply e287–8CrossRefGoogle Scholar
  14. Simpson JM. Fetal arrhythmias. Ultrasound Obstet Gynecol. 2006;27:599–606.CrossRefGoogle Scholar
  15. Simpson JM, Maxwell D, ROSENTHAL E, GILL H. Fetal ventricular tachycardia secondary to long QT syndrome treated with maternal intravenous magnesium: case report and review of the literature. Ultrasound Obstet Gynecol. 2009;34:475–80.CrossRefGoogle Scholar
  16. Simpson JM, Sharland GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart. 1998;79:576–81.CrossRefGoogle Scholar
  17. Vigneswaran TV, Callaghan N, Andrews RE, Miller O, Rosenthal E, Sharland GK, Simpson JM. Correlation of maternal flecainide concentrations and therapeutic effect in fetal supraventricular tachycardia. Heart Rhythm. 2014;11:2047–53.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation TrustLondonUK
  2. 2.King’s College Hospital NHS Foundation TrustLondonUK

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