Perin F, Rodríguez Vázquez del Rey M M, Deiros Bronte L, Ferrer Menduiña Q, Rueda Nuñez F, Zabala Arguelles J I, García de la Calzada D, Teodoro Marin S, Centeno Malfaz F, Galindo Izquierdo A
Unidad de Cardiología Pediátrica, Hospital Universitario Virgen de las Nieves, Granada, España.
Unidad de Cardiología Pediátrica, Hospital Universitario Virgen de las Nieves, Granada, España.
An Pediatr (Barc). 2014 Nov;81(5):275-82. doi: 10.1016/j.anpedi.2013.12.020. Epub 2014 Feb 16.
The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers.
Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography.
A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months.
Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial.
本研究旨在回顾西班牙9个中心目前对胎儿心动过缓的管理及治疗结果。
回顾性多中心研究：分析2008年1月至2010年9月期间诊断为心动过缓的所有胎儿。采用超声心动图研究胎儿心律失常的潜在机制。
共记录37例病例：3例窦性心动过缓，15例房性二联律阻滞，19例高度房室传导阻滞。窦性心动过缓：3例（100%）与严重疾病相关。除1例产后发生快速性心律失常外，房性二联律阻滞预后良好。在房室传导阻滞中，16%与先天性心脏缺陷伴异构有关，63%与母亲抗SSA/Ro抗体的存在有关，21%病因不明。总体死亡率为20%（若将终止妊娠考虑在内则为37%）。死亡的危险因素为先天性心脏病、水肿和/或心室功能障碍。各中心的管理策略有所不同。73%的免疫介导性房室传导阻滞使用了类固醇，包括唯一的免疫介导性Ⅱ度阻滞。超过一半（58%）的房室传导阻滞在18个月的随访中植入了起搏器。
持续性胎儿心动过缓在所有病例中都需要进行全面研究，包括窦性心动过缓的病例。房性二联律阻滞预后良好，但可能会发生快速性心律失常。心脏传导阻滞有显著的死亡率和发病率，其管理仍存在很大争议。
