Abstract 11382: Left and Right Ventricular Strain Mechanics in Fetal Arrhythmia

Abstract

Introduction: Assessment of ventricular mechanics in fetuses with tachyarrhythmia poses significant challenges. Strain analysis measures myocardial deformation and has been shown to be a very sensitive marker of ventricular systolic dysfunction compared to traditional measurements. Global and regional myocardial deformation has not been well described in fetuses with arrhythmias. Hypothesis: We hypothesize that left and right ventricular myocardial mechanics are impaired in fetuses with tachyarrhythmias compared to normal fetuses in sinus rhythm. Methods: Retrospective review of fetuses with tachyarrhythmia (groups 1 and 2) and gestational age (GA) matched normal fetuses with normal cardiac anatomy (group 3) from 2000 to 2018 at a single institution, with IRB approval. Fetuses with isolated ectopy and congenital heart disease were excluded from all groups. Strain analysis was performed using VVI software. Arrhythmia type, medications, cardiovascular profile score and postnatal outcome were collected. Results: 18 fetuses with tachyarrhythmia with GA between 21 to 36.5 weeks were analyzed; 18 fetuses of similar GA with normal cardiac anatomy in sinus rhythm served as controls. 3 fetuses were delivered close to term and did not have strain assessment in sinus rhythm. Both LV global longitudinal strain (-4.44 ± 2.82%) and strain rate (-1.24 ± 0.85%) and RV global longitudinal strain (-6.76 ± 2.09%) and strain rate (-1.41 ± 0.55%) were reduced in tachyarrhythmia (Group 1) and recovered when in sinus rhythm (Group 2) but still reduced compared to controls (Group 3). Global longitudinal velocity was not different between patients in Group 2 and 3 (Table & Fig 1). Conclusions: Strain parameters remain abnormal in fetuses with tachyarrhythmia despite conversion to sinus rhythm when compared to GA matched controls. Serial evaluation of strain will help guide therapy and monitor ventricular function in this patient population.