Lisa Howley, Michelle Carr, Fetal Arrhythmias, Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 10.1007/978-1-4471-4619-3, (271-291), (2014). Acute treatment should be initiated based on the underlying mechanism. Machado MVL, Tynan M, Curry PVL, Allen LD, Fetal complete heart block, Br Heart J, 1988;56:512–15. Antiarrhythmic agents that have been used to treat foetal arrhythmias include digoxin, beta-blocking agents, verapamil, procainamide and quinidine. There is a 1-to-1 atrioventricular conduction. In addition, verapamil is capable of causing foetal bradycardia, high-degree AV block and hypotension. described three cases with hydrops fetalis due to supraventricular tachyarrhythmias successfully treated with amiodarone and digoxin or the combination of digoxin, procainamide and propranolol.40. A fetal bradyarrhythmia can fall into several types which include. Auszug aus Kinder- und Jugendarzt – Zeitschrift des Berufsverbandes der Kinder- und Jugendärzte e.V. Sie haben zum Teil unterschiedliche Ursachen und demzufolge auch eine unterschiedliche Bedeutung und therapeutische Konsequenz Correct treatment of arrhythmias in the intensive care patient should be based on understanding the causal mechanism. APBs in pregnant woman with structurally normal hearts are benign.10 APBs may become more frequent during pregnancy, or they may develop for the first time; many patients are worried about it.13 Patient education and reassurance is the first level of intervention of this benign condition. In another publication, Khosithseth et al. Before initiating therapy, it is important to correctly diagnose the type and mechanism of the underlying arrhythmia so that the proper therapeutic modalities can be implemented. War dann alles ok mit euren Mäusen nach der Geburt? Check for errors and try again. SS) die bei bekanntem hypoplastischem Links-Herz-Syndrom des Kindes spontan entbindet. The few randomised studies of their use in pregnancy have yielded conflicting results regarding their effectiveness and safety. VT or ventricular fibrillation (VF) was not recorded in any of the patients.14. fetal supraventricular tachycardia (SVT) most common fetal tachyarrhythmia: accounts for 60-90% of cases; has a typical ventricular rate of ~230-280 beats per minute (bpm) 4; often associated with an accessory AV conduction pathway; fetal atrial flutter. This is possible in the majority of patients using a 12-lead surface ECG. 3. Strasburger JF, Cuneo BF, Michon MM, et al., Amiodarone therapy for drug-refractory fetal tachycardia, Circulation, 2004;109:375–9. Julkunen H, Kaaja R, Siren MK, et al., Immune-mediated congenital heart block (CHB): identifying and counselling patients at risk for having children with CHB, Semin Arthritis Theum, 1998;28:97–106. Bei Aufnahme und unter der Geburt fielen schwere fetale Bradykardien auf. Drug therapy is not needed in the vast majority of pregnant women. Lupoglazoff JM, Dejoy I, Luton D, et al., Prenatal diagnosis of a familial form of junctional ectopic tachycardia, Prenat Diagn, 1999;19:767–70. Er meinte das Hezr würde sich aber noch entwickeln! Neonaten von Müttern mit OSAS zählen die vorzeitige Geburt, häufigere Entbindung per Sectio caesarea, ein niedriges bzw. Types of tachycardia. Their diagnosis is important in the fetal stage as it might help provide an opportunity to plan and manage the baby as and when the baby is born. Hubinont C, Debauche C, Bernard P, Sluysmans T, Resolution of fetal tachycardia and hydrops by a single adenosine administration, Obstet Gynecol, 1998;92:718–20. Amiodarone is well known for its many and serious side effects for both the mother and the foetus, including hypothyroidism, growth retardation and premature delivery.40,41 There is limited experience of amiodarone during pregnancy, and treatment with this drug should be reserved for life-threatening conditions.42 Magnesium is another drug with antiarrhythmic properties, particularly in patients with torsade de pointes tachycardia due to QT prolongation. It has a typical ventricular rate of 230-280 beats per minute (bpm) 1 and isoften associated with an accessory AV conduction pathway. Of the 100 patients with atrioventricular (AV) nodal re-entrant tachycardia, one had the first onset of tachycardia during pregnancy. Fetale Chirurgie bei Spina bifida . Vanbesien J, Casteels A, Bougatef A, et al., Transient fetal hypothyroidism due to direct fetal administration of amiodarone for drug resistant fetal tachycardia, Am J Perinatol, 2001;18:113–16. Antwort: Arrhythmie beim Ungeborenen. It is possible to determine the atrial rate using M-mode echocardiography, while the ventricular rate is determined with the use of M-mode and/or echo-Doppler. M-mode echocardiography uses a sampling line placed across atrial and ventricular walls and times electromechanical events in the fetal cardiac cycle. Exacerbating factors, such as chemical stimulants, should be identified and eliminated. Eight of these fetuses displayed signs of redundancy/aneurysm of the foramen ovale, all in combination with various atrial arrhythmias. Auflage. ‘Conservative’ therapy is indicated in any patient with sustained VT and stable haemodynamics (see Figure 2). Fetale Chirurgie bedeutet die Durchführung von operativen Eingriffen am Ungeborenen mit dem Ziel der intrauterinen Korrektur von Mißbildungen, die das Leben des Kindes bereits pränatal gefährden oder die postnatal den Tod oder … ), Fetal and neonatal cardiology, Philadelphia: WB Saunders Company, 1990:180–84. Die Schwangeren zeigen in den häufigsten Fällen keine klinischen Auffälligkeiten. Mozo de Rosales F, Moreno J, Bodegas A, et al., Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome, Eur J Obstetrics, 1994;56: 63–6. The advantage of adenosine 9–18mg intravenous (IV) as bolus relative to intravenous calcium antagonists or beta-blockers relates to its rapidity of onset and short half-life.34 In addition, the current reported human clinical experience with adenosine during pregnancy indicates no teratogenicity or other adverse effects to the foetus, and it is as effective in terminating SVT (efficacy rates >90%) in pregnant woman as it is in patients who are not pregnant. Offene fetale Chirurgie bei Spina bifida. Specific antiarrhythmic drugs should be avoided whenever possible in these conditions, because all commonly used antiarrhythmic drugs cross the placenta and may cause serious side effects to the foetus. Amiodarone seems to be the drug of choice for direct therapy; however, there are also other effective drugs (digoxin, beta-blocking agents, flecainide, adenosin).50,51 Despite the many side effects of amiodarone, the majority of children in the perinatal period are completely normal despite intrauterine therapy with amiodarone for tachyarrhythmias. irregular fetal bradycardia.. Interdisziplinäre Diagnostik, Therapie und Beratung. Yifei Li, Jie Fang, Kaiyu Zhou, Chuan Wang, Yimin Hua, Xiaoqing Shi, Dezhi Mu, Prediction of fetal outcome without intrauterine intervention using a cardiovascular profile score: a systematic review and meta-analysis, The Journal of Maternal-Fetal & Neonatal Medicine, 10.3109/14767058.2014.974536, 28, 16, (1965-1972), (2015). Blutgruppe, die in diesem Fall den Fetus offenbar vom Vater geerbt hat. In pregnant women with maternal and/or foetal arrhythmias, therapeutic strategies should be based on interdisciplinary co-operation (obstetrics, cardiology, neonatology). The diagnosis of supraventricular tachycardia can be established using M-mode echocardiography, which may demonstrate paroxysms of atrial tachycardia in the range of 230 - 280 beats per minute (BPM), often following an extra-systole. Khositseth A, Ramin KD, O’Leary PW, Porter CJ, Role of amiodarone in the treatment of fetal supraventricular tachyarrhythmias and hydrops fetalis, Pediatr Cardiol, 2003;24:454–56. Wide-QRS-complex tachycardias (QRS duration >0.12s) often pose a difficult diagnostic and therapeutic problem.21 Errors are made because emergency care professionals wrongly consider VT unlikely if the patient is young and haemodynamically stable, and they are often unaware of the ECG findings that quickly and accurately distinguish VT in more than 90% of cases. In addition, the β-adrenergic properties of sotalol must be considered. Hunter S, Robson SC, Adaptation of maternal heart in pregnancy, Br Heart J, 1992;68:540–43. In regular narrow-QRS-complex tachycardia (QRS width <0.12s), vagal manoeuvres should be initiated to terminate the arrhythmia or to modify AV conduction.21,33 If this fails, adenosine or calcium channel blockers (verapamil) are the drugs of first choice (see Figure 1). The authors concluded that various haemodynamic and neurohumoral changes associated with pregnancy play an important role in ventricular arrhythmogenesis.8 In women with well-known recurrent episodes of SVTs, 14 of the 63 patients (22%) with tachycardia in the pregnant and non-pregnant periods had exacerbation of symptoms during pregnancy.18 Similar observations have been reported by others.19,20, Shotan et al14 assessed the relationship between symptoms and cardiac arrhythmias in 110 consecutive pregnant patients without evidence of heart disease referred for evaluation of palpitations, dizziness and syncope (group G I). In addition, umbilical drug administration allows not only direct treatment but also drug monitoring. Feasibility of long-term fECG recordings ª 2008 The Authors Journal compilation ª RCOG 2008 BJOG An International Journal of Obstetrics and Gynaecology 335. a maximum of 100% from about 12 p.m. until 6 a.m. Fetale Arrhytmien (Herzrhythmusstörungen beim Baby): Hallo Mädels, hat Jemand von euch Erfahrungen mit einer fetalen Arrhytmie, sprich bei Unregelmäßigkeiten der Herztöne beim Ungeborenen? These patients were compared with 52 consecutive pregnant patients referred for evaluation of symptomatic functional precordial murmur (group G II). Because a drug given for the treatment of SVT may be deleterious to a patient with VT, the differential diagnosis of a broad QRS tachycardia is critical. The definitive diagnosis of narrow-QRS-complex tachycardia can be made in most patients based on the 12-lead ECG and clinical criteria. Die Herzvorhöfe beginnen zu „flimmern“, d.h., ihre geordn: Pressemitteilung: Vorhofflimmern behandeln A safe combination?, Circulation, 1997;96:2808–12. second most common fetal tachyarrhythmia 7: can account for up to 25% of cases ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia. Fetale Arrhythmien sind Rhythmusstörungen, welche in der Fetalperiode entstehen oder in dieser diagnostiziert werden. Speranza G, Verlato G, Albiero A, Autonomic changes during pregnancy: assessment by spectral heart rate variability analysis, J Electro Cardiol, 1998;31:101–9. If at any time VT becomes unstable or there is evidence of foetal compromise, DC countershock (50–100J) should be delivered immediately (see Figure 1).