Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; Fetal Medicine Unit, St George's University Hospital, Blackshaw Road, London, SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
Best Pract Res Clin Obstet Gynaecol. 2019 Jul;58:28-41. doi: 10.1016/j.bpobgyn.2019.01.002. Epub 2019 Jan 9.
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
胎儿心律失常较为常见，通常表现为节律不规则。尽管大多数不规则是良性的，由孤立性房性异位引起，但在少数情况下，节律不规则可能提示部分房室传导阻滞，这具有不同的病因和预后意义。我们提供了一个初始处理不规则节律的流程图，以帮助选择需要紧急专科转诊的病例。心动过速和心动过缓则不太常见，可导致血液动力学受损，可能需要宫内治疗。心动过速的药物治疗取决于类型（室上性心动过速或心房扑动）和是否存在水肿，地高辛、氟卡尼和索他洛尔是常用药物。正在进行的随机试验可能会更好地说明它们的疗效。由于成对出现的二联律引起的心动过缓通常会自发缓解，但如果是由于已确立的完全性心脏阻滞引起的，则没有有效的治疗方法。正在进行的研究表明羟氯喹可能降低自身免疫性房室传导阻滞的风险。窦性心动过缓（速率<第 3 百分位数）可能是长 QT 综合征的产前标志物。
