Abstract
BackgroundFetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Despite a transplacental treatment, failure to obtain or maintain sinus rhythm may occur.ObjectiveWe aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment.MethodsWe performed a retrospective evaluation of 69 cases with sustained fetal tachyarrhythmia. We compared the perinatal and long-term outcomes of prenatally converted and drug-resistant fetuses. Tachyarrhythmia subtypes were also evaluated.ResultsConversion to sinus rhythm was obtained in 74% of cases; 26% of cases were drug-resistant and delivered arrhythmic. Three perinatal deaths occurred in both groups (6.7% vs 17%, P = .34). Neonates delivered arrhythmic were more frequently admitted to neonatal intensive care units (75% vs 31%, P < .01), and their hospital stay was longer (20.9 vs 6.64 days, P < .001). Multiple neonatal recurrences (81% vs 11%, P < .001), temporary hemodynamic dysfunction or heart failure (50% vs 6.7%, P < .001), and postnatal use of a combination treatment (44% vs 13%, P = .028) were also more frequent in this population. Beyond the neonatal period, rates of recurrences within the first 16 months were higher in drug-resistant fetuses (HR = 16.14, CI 95% [4.485; 193.8], P < .001). In this population, postnatal electrocardiogram revealed an overrepresentation of rare mechanisms, especially permanent junctional reciprocating tachycardia (PJRT) (31%).ConclusionPrenatal conversion to stable sinus rhythm is a major determinant of perinatal and long-term outcomes in fetal tachyarrhythmias. The underlying electrophysiological mechanisms have a major role in predicting these differential outcomes with an overrepresentation of PJRT in the drug-resistant population.
Highlights
The prevalence of fetal arrhythmias appears to be around 1%–2% of pregnancies, it is probably underestimated, as intermittent arrhythmias and spontaneous resolution may occur.[1,2] The most common type of arrhythmia is ectopic atrial beats, a benign condition in 95% of cases.[3]
Postnatal electrocardiogram revealed an overrepresentation of rare mechanisms, especially permanent junctional reciprocating tachycardia (PJRT) (31%)
The causes of supraventricular tachycardia (SVT) have been well established with 2 main mechanisms: atrioventricular reciprocating tachycardia (AVRT) through an accessory pathway (AP) and atrial flutter, accounting for 70%–80% and 20%–30% of fetal tachyarrhythmias, respectively.[5]
Summary
The prevalence of fetal arrhythmias appears to be around 1%–2% of pregnancies, it is probably underestimated, as intermittent arrhythmias and spontaneous resolution may occur.[1,2] The most common type of arrhythmia is ectopic atrial beats, a benign condition in 95% of cases.[3]. The rationale for transplacental antiarrhythmic treatment (TPT) is to restore sinus rhythm to prevent hydrops and intrauterine death, and potentially allow for vaginal delivery when stable sinus rhythm has been obtained.[8,9] the overall efficacy of medical transplacental therapies is undisputed, failures and recurrences occur,[10,11,12,13] accounting for a large proportion of the perinatal morbidity and mortality of the condition. Fetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Failure to obtain or maintain sinus rhythm may occur
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