Importance of Analysis of Arrhythmia Mechanism in Predicting Outcomes in Fetal Bradycardia: A Single-Centre Retrospectiv
- PDF / 3,305,478 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 129 Views
ORIGINAL ARTICLE
Importance of Analysis of Arrhythmia Mechanism in Predicting Outcomes in Fetal Bradycardia: A Single-Centre Retrospective Study from a Dedicated Fetal Cardiology Unit in South India Jasmine Lall1 • Roshan Valsan1 • Anu Paul1 • Stephy Thomas1 • Abish Sudhakar1 Balu Vaidyanathan1
•
Received: 15 May 2020 / Accepted: 10 August 2020 Ó Society of Fetal Medicine 2020
Abstract Few studies have correlated the mechanism of fetal bradycardia to pregnancy outcomes. This study aimed to correlate the arrhythmia mechanism to pregnancy and early postnatal outcomes in fetal bradycardia. This was retrospective study (May 2013–November 2019). Fetuses with sustained bradycardia (heart rate B 100 per minute) were included. Based on arrhythmia mechanism, patients were categorized into 4 groups:Group 1: blocked atrial ectopics, Group 2: second-degree atrioventricular block (AVB), Group 3: complete AVB and group 4: sinus bradycardia. Clinical presentation, need for transplacental therapy, pregnancy and early postnatal outcomes were analysed. A total of 36 patients were included. Mean gestational age was 26.2 ± 5.5 weeks. The most common arrhythmia mechanism was Group 3 (N = 24; 66.7%) followed by Group 2 (N = 5; 13.8%); groups 1 and 4 had 4 and 3 patients respectively. Maternal auto-antibodies were reported in 21 patients (58.3%); 19 were in Group 3. Transplacental therapy was needed in 15 (41.7%) cases; 14 were in Group 3. Live-birth was reported in 23 cases (63.9%), other outcomes included pregnancy termination (n = 7), intra-uterine death (n = 4) and lost to follow-up (n = 2). Live-births were most common in Groups 1 (100%) and 2 (80%), followed by Group 3 (54.2%). Postnatal mortality occurred in one patient (Group 2). Three patients (60%) in Group 2 had Long QT syndrome in postnatal evaluation. Eight patients (6 in group 3) needed pacemaker implantation after birth. Fetal bradycardia was
& Balu Vaidyanathan [email protected] 1
The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala 682 041, India
associated with an overall favorable pregnancy and good early postnatal outcomes. Analysis of the arrhythmia mechanism should guide prognostication and decisions for transplacental therapy. Keywords Fetal bradycardia Arrhythmia mechanism Perinatal outcomes
Introduction Abnormalities of fetal heart rate and rhythm constitute about 10% of referrals for fetal echocardiography evaluation [1]. Fetal bradycardia is defined as a heart rate B 100 beats per minute (bpm) [2] and is classified as sustained if lasts through the major part ([ 50%) of a study lasting 45 min [3]. Sustained fetal bradycardia can be due to sinus bradycardia, blocked atrial ectopics or second- or thirddegree atrioventricular block (AVB) [4–6]. Complete (or third degree) AVB is one of the common causes of fetal bradycardia. This can occur along with associated congenital heart defects (CHD) or in structurally normal hearts in the presence of maternal autoimmune disease associat
Data Loading...
