Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Heart Rhythm. 2022 Aug;19(8):1343-1349. doi: 10.1016/j.hrthm.2022.04.013. Epub 2022 Apr 21.
Antiarrhythmic treatment of fetal supraventricular tachycardia (SVT) is used to prevent morbidity and mortality. The postnatal management of survivors is often arbitrary and varied.
The purpose of this study was to examine the utility of a risk-based postnatal management strategy.
Sixty-six prenatally treated newborns with fetal long or short ventriculoatrial tachycardia were reviewed. Postnatal diagnoses included atrioventricular reentrant tachycardia, atrial ectopic tachycardia, and permanent junctional reciprocating tachycardia. Unless SVT persisted to birth, early neonatal observation without treatment was recommended. For newborns without spontaneous arrhythmia after ≥2 days of observation, inducibility was tested by transesophageal pacing study (TEPS). Postnatal therapy was advised for spontaneous or inducible SVT. Characteristics associated with these outcomes were analyzed.
Twenty-eight patients (42%) experienced SVT at or early after birth, which was associated with fetal long ventriculoatrial tachycardia (odds ratio [OR] 6.8; 95% confidence interval [CI] 1.88-24.57; P = .0029); delayed in utero cardioversion with treatment (median 11 days vs 5.5 days; P < .0001); prenatal treatment with multiple antiarrhythmics (OR 4.42; 95% CI 1.56-12.55; P = .0059); and postnatal atrial ectopic tachycardia/permanent junctional reciprocating (OR 18.0; 95% CI 2.11-153.9; P = .0013). Of the 38 neonates undergoing TEPS, 19 (50%) had inducible tachyarrhythmias. Recurrence of SVT during infancy or childhood was documented in 4 of 6 patients with SVT at birth (66%), 8 of 22 patients with early neonatal SVT (36%), 4 of 19 patients with inducible SVT (21%), and 0 of 19 untreated patients without inducible SVT (0%) (P = .0032).
The postnatal risk of SVT is related to the arrhythmia mechanism and prenatal treatment response. In newborns without spontaneous SVT, TEPS may be useful to guide the need for postnatal treatment on the basis of SVT inducibility.
抗心律失常治疗胎儿室上性心动过速（SVT）用于预防发病率和死亡率。幸存者的产后管理通常是任意和多样化的。
本研究旨在检验基于风险的产后管理策略的实用性。
回顾了 66 例产前治疗的新生儿，其胎儿长或短室房性心动过速。产后诊断包括房室折返性心动过速、房性心动过速和永久性交界性折返性心动过速。除非 SVT 持续到分娩，否则建议在新生儿早期观察期间不进行治疗。对于观察≥2 天后无自发性心律失常的新生儿，通过经食管起搏研究（TEPS）测试诱发性。建议对自发性或诱发性 SVT 进行产后治疗。分析了与这些结果相关的特征。
28 例（42%）患者在出生时或出生后早期出现 SVT，这与胎儿长室房性心动过速（比值比 [OR] 6.8；95%置信区间 [CI] 1.88-24.57；P =.0029）、延迟宫内电复律治疗（中位数 11 天与 5.5 天；P <.0001）、产前使用多种抗心律失常药物（OR 4.42；95%CI 1.56-12.55；P =.0059）和产后房性心动过速/永久性交界性折返（OR 18.0；95%CI 2.11-153.9；P =.0013）有关。在 38 例行 TEPS 的新生儿中，19 例（50%）诱发性心动过速。在出生时患有 SVT 的 6 例患者中的 4 例（66%）、新生儿早期 SVT 的 22 例患者中的 8 例（36%）、可诱发性 SVT 的 19 例患者中的 4 例（21%）和无诱发性 SVT 的 19 例未治疗患者中的 0 例（0%）（P =.0032）记录到婴儿期或儿童期 SVT 的复发。
SVT 的产后风险与心律失常机制和产前治疗反应有关。在无自发性 SVT 的新生儿中，TEPS 可根据 SVT 的诱发性来指导是否需要产后治疗。
