Outcomes of sustained fetal tachyarrhythmias after transplacental treatment

Heart Rhythm O2

Julien Stirnemann, MD¹  Yves Ville, MD¹  Alice Maltret, MD¹  Muriel Nicloux, MD²  Damien Bonnet, MD³  Raphael Bartin, MD⁴ 

[1] Hôpital universitaire Necker-Enfants malades, AP-HP;M3C-Necker, Pediatric and Congenital Cardiology Unit;Neonatology and Neonatal Intensive Care Unit;Obstetric and Maternal Fetal Medicine and EA7328;

关键词: Congenital heart defect;    Echocardiography;    Fetal arrhythmia;    Fetal ultrasound;    In utero therapy;    Tachyarrhythmia;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Fetal 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. Objective: We aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment. Methods: We 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. Results: Conversion 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%). Conclusion: Prenatal 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.

【 授权许可】

Unknown