Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Sport Sciences and Cardiovascular Research, Faculty of Engineering and Sport Sciences, Swansea University, Swansea, UK.
Pediatr Cardiol. 2021 Apr;42(4):849-856. doi: 10.1007/s00246-021-02549-6. Epub 2021 Jan 29.
To investigate prenatal and postnatal outcomes of atrial flutter and its association with the development of a second tachycardia, following restoration of sinus rhythm, in the fetus or newborn. This study is a retrospective review of all fetuses that presented with atrial flutter from January 2001 to December 2019 at the University Hospital of Wales, Cardiff, UK. The specific type of arrhythmia, its time of appearance and clinical characteristics, echocardiographic findings, medical management, and postnatal outcomes were evaluated. Sixteen fetuses were diagnosed with atrial flutter (AFL). Thirteen fetuses had persistent AFL and three fetuses had intermittent AFL. Seven patients had hydrops, of which one had Ebstein's anomaly and the other six had normal hearts. Three of the fetuses that presented with AFL were diagnosed at 20, 21, and 23 weeks' gestation and the remainder were diagnosed in the third trimester. Thirteen patients with AFL received antiarrhythmic drugs and three were delivered without any treatment. Five fetuses with AFL developed atrioventricular reciprocating tachycardia following DC cardioversion after birth, and four of them exhibited pre-excitation on the ECG. These five patients (31.3%) required postnatal antiarrhythmic treatment for up to 2 years. Pre-excitation disappeared in two patients during follow-up and two asymptomatic patients with neonatal pre-excitation required accessory pathway ablation. Fetal atrial flutter has a strong association with atrioventricular reciprocating tachycardia and ventricular pre-excitation in the neonatal period. Therefore, electrocardiograms should be carefully reviewed in newborns following the initial resolution of atrial flutter.
探讨胎儿期和新生儿期心房扑动（atrial flutter）的产前和产后结局，以及其与窦性节律恢复后胎儿或新生儿发生第二种心动过速的关系。本研究回顾性分析了 2001 年 1 月至 2019 年 12 月期间在英国卡迪夫威尔士大学医院就诊的所有患有心房扑动的胎儿。评估了心律失常的具体类型、出现时间和临床特征、超声心动图结果、药物治疗以及产后结局。16 例胎儿被诊断为心房扑动（AFL）。13 例胎儿持续性 AFL，3 例胎儿间歇性 AFL。7 例患者存在水肿，其中 1 例存在埃布斯坦畸形，其余 6 例心脏正常。3 例以 AFL 表现的胎儿在 20、21 和 23 周时被诊断，其余在孕晚期被诊断。13 例 AFL 患者接受了抗心律失常药物治疗，3 例未接受任何治疗而分娩。5 例 AFL 胎儿在出生后直流电复律后出现房室折返性心动过速，其中 4 例心电图显示预激。这 5 例患者（31.3%）需要进行长达 2 年的新生儿期抗心律失常治疗。2 例患者在随访过程中预激消失，2 例无症状的新生儿预激患者需要行旁路消融。胎儿心房扑动与新生儿期房室折返性心动过速和心室预激密切相关。因此，在心房扑动初始缓解后，应仔细检查新生儿的心电图。
