Maragnès P, Fournier A, Lessard M, Fouron J C
Unité de cardiologie foetale, service de cardiologie, hôpital Ste-Justine, Montréal, Québec, Canada.
Pediatrie. 1991;46(5):481-8.
From January 1986 to August 1990, a fetal arrhythmia was diagnosed in 97 pregnant women referred to our unit. Atrial or ventricular extrasystoles were the most frequent rhythm disturbance encountered (71%). They were always well tolerated and all disappeared during the perinatal period. Tachycardia was found in 16 fetuses; 6 had a supraventricular reentrant tachycardia, 6 an atrial chaotic tachycardia, 1 an ectopic atrial tachycardia and the remaining 3 an atrial flutter. A congenital heart malformation was present in 4 fetuses. The arrhythmia induced hydrops fetalis in 25% of cases. One hydropic fetus died in utero and another needed premature delivery. Bradycardia was diagnosed in 12 cases, 3 had benign atrial blocked extrasystoles, 3 others sinus bradycardia due to fetal distress and 6 atrio-ventricular block. Atrio-ventricular block was associated with congenital malformation in 4 cases (66%). All these fetuses were hydropic and died. The 2 fetuses without cardiac malformation tolerated well their bradycardia during fetal life. Fetal arrhythmia is not rare, but in most cases is benign. Sustained tachycardia requires prompt treatment, because when hydrops fetalis appears the prognosis is worse. The major prognostic factor for atrio-ventricular block is the association with a cardiac malformation.
1986年1月至1990年8月期间，我院共诊治了97例被转诊的孕妇，诊断为胎儿心律失常。房性或室性期前收缩是最常见的心律失常（71%）。这些心律失常通常耐受性良好，在围产期均消失。16例胎儿出现心动过速；其中6例为室上性折返性心动过速，6例为房性紊乱性心动过速，1例为异位房性心动过速，其余3例为心房扑动。4例胎儿合并先天性心脏畸形。心律失常在25%的病例中导致胎儿水肿。1例水肿胎儿死于宫内，另1例需要早产。12例诊断为心动过缓，3例为良性房性阻滞性期前收缩，3例因胎儿窘迫出现窦性心动过缓，6例为房室传导阻滞。4例（66%）房室传导阻滞合并先天性畸形。所有这些胎儿均水肿并死亡。2例无心脏畸形的胎儿在胎儿期对心动过缓耐受性良好。胎儿心律失常并不罕见，但大多数情况下是良性的。持续性心动过速需要及时治疗，因为一旦出现胎儿水肿，预后更差。房室传导阻滞的主要预后因素是合并心脏畸形。
