Srinivasan Shardha, Strasburger Janette
Division of Cardiology, Department of Pediatrics, American Family Children's Hospital, University of Wisconsin, Madison 53201, USA.
Curr Opin Pediatr. 2008 Oct;20(5):522-31. doi: 10.1097/MOP.0b013e32830f93ec.
Though fetal arrhythmias account for a small proportion of referrals to a fetal cardiologist, they may be associated with significant morbidity and mortality. The present review outlines the current literature with regard to the diagnosis and, in brief, some management strategies in fetal arrhythmias.
Advances in echocardiography have resulted in significant improvements in our ability to elucidate the mechanism of arrhythmia at the bedside. At the same time, magnetocardiography is broadening our understanding of mechanisms of arrhythmia especially as it pertains to ventricular arrhythmias and congenital heart block. It provides a unique window to study electrical properties of the fetal heart, unlike what has been available to date. Recent reports of bedside use of fetal ECG make it a promising new technology. Fetal magnetocardiography is also developing. The underlying mechanisms resulting in immune-mediated complete heart block in a small subset of 'at-risk' fetuses is under investigation.
There have been great strides in noninvasive diagnosis of fetal arrhythmias. However, we still need to improve our knowledge of the electromechanical properties of the fetal heart as well as the mechanisms of arrhythmia to further improve outcomes. Multiinstitutional collaborative studies are needed to help answer some of the questions regarding patient, drug selection and management algorithms.
尽管胎儿心律失常在转诊至胎儿心脏病专家的病例中占比很小，但它们可能与显著的发病率和死亡率相关。本综述概述了目前关于胎儿心律失常诊断的文献，并简要介绍了一些管理策略。
超声心动图的进展使我们在床边阐明心律失常机制的能力有了显著提高。与此同时，磁心动图正在拓宽我们对心律失常机制的理解，特别是与室性心律失常和先天性心脏传导阻滞相关的机制。它为研究胎儿心脏的电特性提供了一个独特的窗口，这是迄今为止所没有的。最近关于床边使用胎儿心电图的报道使其成为一项有前景的新技术。胎儿磁心动图也在发展。一小部分“高危”胎儿中导致免疫介导的完全性心脏传导阻滞的潜在机制正在研究中。
胎儿心律失常的无创诊断取得了很大进展。然而，我们仍需要提高对胎儿心脏机电特性以及心律失常机制的认识，以进一步改善治疗结果。需要多机构合作研究来帮助回答一些关于患者、药物选择和管理算法的问题。
