Abstract
Fetal arrhythmias are mostly benign and transient. However, some of them are associated with structural defects or can cause heart failure, fetal hydrops, and can lead to intrauterine death. The analysis of fetal heart rhythm is based on ultrasound (M-mode and Doppler echocardiography). Irregular rhythm due to atrial ectopic beats is the most common type of fetal arrhythmia and is generally benign. Tachyarrhythmias are diagnosed when the fetal heart rate is persistently above 180 beats per minute (bpm). The most common fetal tachyarrhythmias are paroxysmal supraventricular tachycardia and atrial flutter. Most fetal tachycardias can be terminated or controlled by transplacental or direct administration of anti-arrhythmic drugs. Fetal bradycardia is diagnosed when the fetal heart rate is slower than 110 bpm. Persistent bradycardia outside labor or in the absence of placental pathology is mostly due to atrioventricular (AV) block. Approximately half of fetal heart blocks are in cases with structural heart defects, and AV block in cases with structurally normal heart is often caused by maternal anti-Ro/SSA antibodies. The efficacy of prenatal treatment for fetal AV block is limited. Our review aims to provide a practical guide for the diagnosis and management of common fetal arrythmias, from the joint perspective of the fetal medicine specialist and the cardiologist.
Highlights
Fetal arrhythmias are detected in 1–2% of pregnancies
180 bpm and are subdivided into: (1) sinus tachycardia (ST); (2) atrial tachycardia; (3) conduction system tachycardia (atrioventricular re-entry tachycardia (AVRT), junctional tachycardia (JT), and atrioventricular nodal re-entry tachycardia (AVNRT); and (4) ventricular tachycardia (VT) [3,6]. This classification can be simplified by dividing tachyarrhythmias into sinus tachycardia (ST), supraventricular tachycardia (SVT), and ventricular tachycardia (VT, rare in fetuses) [3,6,7,9,10,11]
The aim of this paper is to provide a practical guide to the obstetricians for the diagnosis and management of common fetal arrhythmias
Summary
Fetal arrhythmias are detected in 1–2% of pregnancies. Most fetal arrhythmias are benign and transient; in some cases, the irregularity of the fetal heart rhythm can indicate a serious condition—either of fetal or maternal origin. There are three main categories of fetal arrhythmias: (1) an irregular rhythm with a normal fetal heart rate (FHR), as a consequence to premature beats or to conduction anomalies; (2) tachyarrhythmias (defined as FHR > 180 beats per minute-bpm), and (3). 180 bpm and are subdivided into: (1) sinus tachycardia (ST); (2) atrial tachycardia (atrial flutter and atrial ectopic tachycardia); (3) conduction system tachycardia (atrioventricular re-entry tachycardia (AVRT), junctional tachycardia (JT), and atrioventricular nodal re-entry tachycardia (AVNRT); and (4) ventricular tachycardia (VT) [3,6] This classification can be simplified by dividing tachyarrhythmias into sinus tachycardia (ST), supraventricular tachycardia (SVT), and ventricular tachycardia (VT, rare in fetuses) [3,6,7,9,10,11]. The aim of this paper is to provide a practical guide to the obstetricians for the diagnosis and management of common fetal arrhythmias
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