Lulić Jurjević Rajka, Podnar Tomaz, Vesel Samo
Cardiology Unit, Children's Hospital Srebrnjak, Zagreb, Croatia.
Cardiol Young. 2009 Sep;19(5):486-93. doi: 10.1017/S1047951109990497. Epub 2009 Aug 18.
To evaluate the diagnosis, clinical features, management and post-natal follow-up in consecutive fetuses identified with tachycardia.
We reviewed consecutive fetuses with tachycardia identified in a single tertiary institution between January, 2001, and December, 2008. We considered several options for management, including no treatment but close surveillance, trans-placental antiarrhythmic therapy in fetuses presenting prior to 36 weeks of gestation, and delivery and treatment as a neonate for fetuses presenting after 36 weeks of gestation. Data was gathered by a review of prenatal and postnatal documentation.
Among 29 fetuses with tachycardia, 21 had supraventricular tachycardia with 1 to 1 conduction, 4 had atrial flutter, 3 had atrial tachycardia, while the remaining fetus had ventricular tachycardia. Of the group, 8 fetuses (27.6%) were hydropic. Transplacental administration of antiarrhythmic drugs was used in just over half the fetuses, delivery and treatment as a neonate in one-quarter, and no intervention but close surveillance in one-sixth of the case. Twenty-six of 29 fetuses (89.7%) were born alive. Only patients with fetal hydrops suffered mortality, with 37.5% of this group dying, this being statistically significant, with the value of p equal to 0.03, when compared to non-hydropic fetuses. Only 3 patients (11.5%) were receiving antiarrhythmic prophylaxis beyond the first year of life.
A significant proportion of fetal tachycardias recognized before 36 weeks of gestation can be treated successfully by transplacental administration of antiarrhythmic drugs. Fetuses presenting after 36 weeks of gestation can be effectively managed postnatally. The long-term prognosis for fetuses diagnosed with tachycardia is excellent, with the abnormal rhythm resolving spontaneously during the first year of life in most of them.
评估连续诊断为心动过速的胎儿的诊断、临床特征、治疗及产后随访情况。
我们回顾了2001年1月至2008年12月在一家三级医疗机构中连续诊断为心动过速的胎儿。我们考虑了几种治疗方案，包括不治疗但密切监测、对妊娠36周前出现的胎儿进行经胎盘抗心律失常治疗，以及对妊娠36周后出现的胎儿作为新生儿进行分娩和治疗。通过查阅产前和产后记录收集数据。
在29例心动过速胎儿中，21例为1:1传导的室上性心动过速，4例为心房扑动，3例为房性心动过速，其余1例为室性心动过速。该组中，8例胎儿（27.6%）出现水肿。略多于一半的胎儿采用经胎盘给予抗心律失常药物治疗，四分之一的胎儿作为新生儿进行分娩和治疗，六分之一的病例未进行干预仅密切监测。29例胎儿中有26例（89.7%）存活出生。只有胎儿水肿的患者死亡，该组中有37.5%死亡，与非水肿胎儿相比，差异有统计学意义，p值等于0.03。只有3例患者（11.5%）在出生后第一年接受抗心律失常预防治疗。
妊娠36周前诊断出的相当一部分胎儿心动过速可通过经胎盘给予抗心律失常药物成功治疗。妊娠36周后出现的胎儿产后可得到有效治疗。诊断为心动过速的胎儿的长期预后良好，大多数胎儿的异常心律在出生后第一年内自发消失。
