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Follow-up of neonates with foetal and neonatal arrhythmias a
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Fernando M. Picchio , Daniela Prandstraller , Gabriele Bronzetti & Elena Cervi a
Paediatric Cardiology Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy Published online: 08 Sep 2012.
To cite this article: Fernando M. Picchio, Daniela Prandstraller, Gabriele Bronzetti & Elena Cervi (2012) Follow-up of neonates with foetal and neonatal arrhythmias, The Journal of Maternal-Fetal & Neonatal Medicine, 25:sup4, 45-45 To link to this article: http://dx.doi.org/10.3109/14767058.2012.714980
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The Journal of Maternal-Fetal and Neonatal Medicine, 2012; 25(S4): 53 © 2012 Informa UK, Ltd. ISSN 1476-7058 print/ISSN 1476-4954 online DOI: 10.3109/14767058.2012.714980
Follow-up of neonates with foetal and neonatal arrhythmias Fernando M. Picchio, Daniela Prandstraller, Gabriele Bronzetti & Elena Cervi Paediatric Cardiology Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy prenatal AVB patients, three patients required neonatal PMK implantation. Data on postnatal follow-up of patients with foetal SVT are few: reports show that about 60–70% of patients develop postnatal arrhythmias, particularly those who did not convert to sinus rhythm prenatally. Foetal AF may also relapse in the first 24–48 h after birth. Although transesophageal overdrive pacing and cardioversion are more effective in AF patients, generally antiarrhythmic pharmacological treatment is successful in SVT. Medical treatment should be continued for the first year of life but the range is variable, as some patients may require longer treatment and eventually transcatheter ablation.
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Keywords: foetal arrhythmias Foetal arrhythmias occur in 1% of all pregnancies and the majority are benign, mainly ectopic beats. However, in about 10% of cases, sustained supraventricular tachycardia (SVT) or atrio-ventricular block (AVB) may cause heart failure, hydrops and eventually foetal death. An accurate analysis of the type of arrhythmia in utero is obtained by means of M-Mode and Doppler echocardiography. Foetal tachycardia is diagnosed when ventricular heart rate (HR) is faster than 180 bpm (up to 200–300 bpm). Paroxysmal SVT and atrial flutter (AF) are the most frequent causes of tachycardia, whereas ventricular tachycardia is very rare in the foetus. The perinatal management of SVT and AF consists of transplacental administration of antiarrhythmic drugs, usually digoxin as first choice and sotalol, flecainide and amiodarone as a second option or in combination. It is worth mentioning that in hydropic foetuses, transplacental distribution of digoxin may be impaired. Postnatal pharmacological treatment is usually successful but very premature babies with unstable haemodynamic conditions and with SVT are at risk, and treatment in utero could be preferable, even in presence of hydrops. Foetal bradyarrhythmia is diagnosed when HR is less than 100 bpm. The most frequent cause is AVB, and in about half of cases there is an associated congenital cardiac malformation; in the other half of cases, cardiac structure is normal and anti-Ro/SSA maternal antibodies are frequently present (in 80% of our series). In rare cases, foetal bradycardia is related to long QT (LQT) syndrome, either with 2:1 AVB or sinus bradycardia; in some cases, blocked premature beats may occur. Foetal bradycardia with congenital heart disease and/or hydrops has a poor prognosis. Efficacy of prenatal treatment for foetal AVB is somewhat discouraging and controversial, as beta stimulators and steroids have been reported to be effective in a minority of cases. Early delivery and neonatal pacing are necessary when foetal HR is less than 55–50 bpm and hydrops is developing. Early implant of a cardiac pace-maker (PMK) is not mandatory in neonates with normal cardiac structure, complete AVB and monitored HR above 50 bpm over the bulk of the day: it can be postponed depending on clinical condition. In our series of 14
Declaration of Interest: The authors report no conflicts of interest.
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Correspondence: Fernando M. Picchio, Paediatric Cardiology Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy. E-mail:
[email protected]
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