Simpson J M, Sharland G K
Department of Fetal Cardiology, Guy's Hospital, London, UK.
Heart. 1998 Jun;79(6):576-81.
To review the management and outcome of fetal tachycardia, and to determine the problems encountered with various treatment protocols.
Retrospective analysis.
127 consecutive fetuses with a tachycardia presenting between 1980 and 1996 to a single tertiary centre for fetal cardiology. The median gestational age at presentation was 32 weeks (range 18 to 42).
105 fetuses had a supraventricular tachycardia and 22 had atrial flutter. Overall, 52 fetuses were hydropic and 75 non-hydropic. Prenatal control of the tachycardia was achieved in 83% of treated non-hydropic fetuses compared with 66% of the treated hydropic fetuses. Digoxin monotherapy converted most (62%) of the treated non-hydropic fetuses, and 96% survived through the neonatal period. First line drug treatment for hydropic fetuses was more diverse, including digoxin (n = 5), digoxin plus verapamil (n = 14), and flecainide (n = 27). The response rates to these drugs were 20%, 57%, and 59%, respectively, confirming that digoxin monotherapy is a poor choice for the hydropic fetus. Response to flecainide was faster than to the other drugs. Direct fetal treatment was used in four fetuses, of whom two survived. Overall, 73% (n = 38) of the hydropic fetuses survived. Postnatally, 4% of the non-hydropic group had ECG evidence of pre-excitation, compared with 16% of the hydropic group; 57% of non-hydropic fetuses were treated with long term anti-arrhythmics compared with 79% of hydropic fetuses.
Non-hydropic fetuses with tachycardias have a very good prognosis with transplacental treatment. Most arrhythmias associated with fetal hydrops can be controlled with transplacental treatment, but the mortality in this group is 27%. At present, there is no ideal treatment protocol for these fetuses and a large prospective multicentre trial is required to optimise treatment of both hydropic and non-hydropic fetuses.
回顾胎儿心动过速的管理及结局，并确定各种治疗方案中遇到的问题。
回顾性分析。
1980年至1996年间连续127例因心动过速就诊于单一胎儿心脏病三级中心的胎儿。就诊时的中位孕周为32周（范围18至42周）。
105例胎儿为室上性心动过速，22例为心房扑动。总体而言，52例胎儿出现水肿，75例未出现水肿。83%接受治疗的非水肿胎儿实现了心动过速的产前控制，而接受治疗的水肿胎儿这一比例为66%。地高辛单一疗法使大多数（62%）接受治疗的非水肿胎儿病情得到缓解，96%存活至新生儿期。水肿胎儿的一线药物治疗更为多样，包括地高辛（n = 5）、地高辛加维拉帕米（n = 14）和氟卡尼（n = 27）。这些药物的有效率分别为20%、57%和59%，证实地高辛单一疗法对水肿胎儿并非理想选择。氟卡尼的起效速度比其他药物更快。4例胎儿接受了直接胎儿治疗，其中2例存活。总体而言，73%（n = 38）的水肿胎儿存活。出生后，非水肿组4%的胎儿心电图有预激表现，而水肿组为16%；57%的非水肿胎儿接受了长期抗心律失常治疗，而水肿组为79%。
经胎盘治疗的胎儿心动过速非水肿胎儿预后良好。大多数与胎儿水肿相关的心律失常可通过经胎盘治疗得到控制，但该组死亡率为27%。目前，对于这些胎儿尚无理想的治疗方案，需要进行大型前瞻性多中心试验以优化水肿和非水肿胎儿的治疗。
