The Heart Institute, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA.
Division of Cardiology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
Ultrasound Obstet Gynecol. 2023 Oct;62(4):552-557. doi: 10.1002/uog.26239. Epub 2023 Sep 6.
While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery.
This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence.
Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7) weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17) days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth.
In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
在有生机儿和早产儿中，胎儿持续性室上性心动过速（SVAs）的宫内治疗是标准做法，但对于晚期早产儿（34+0 至 36+6 周）、早期足月（37+0 至 38+6 周）和足月（>39 周）胎儿持续性 SVA 的最佳治疗方法的数据有限。我们回顾了在六家机构接受治疗而非立即分娩的≥35 孕周胎儿的分娩和产后结局。
这是一项回顾性病例系列研究，纳入了 2012 年至 2022 年期间在≥35 孕周出现持续性 SVA 并在六家机构接受宫内治疗的胎儿。收集了胎儿就诊时和分娩时的胎龄、SVAs 诊断（短室房性心动过速、长室房性心动过速或房扑）、使用的抗心律失常药物类型、治疗至窦性心律恢复的时间间隔以及产后 SVA 复发情况。
共有 37 例胎儿在中位胎龄 35.7（范围，35.0-39.7）周时出现短室房性心动过速（n=20）、长室房性心动过速（n=7）或房扑（n=10）。4 例（11%）胎儿出现水肿。宫内治疗使 35 例（95%）胎儿在中位时间 2（范围，1-17）天恢复窦性心律，其中包括 4 例水肿胎儿。抗心律失常药物包括氟卡尼（n=11）、地高辛（n=7）、索他洛尔（n=11）和双重治疗（n=8）。新生儿在 36-41 周时经自然阴道分娩（23/37（62%））或剖宫产分娩（14/37（38%））。两名胎儿因胎儿 SVA、三名胎儿因房性期前收缩或窦性心动过缓、九名胎儿因产科原因行剖宫产分娩，这些胎儿在分娩时处于窦性心律。21 例（57%）病例在产后出现复发性 SVA 接受治疗。
即使存在水肿，宫内治疗近期和足月（≥35 孕周）SVA 胎儿的成功率也很高，大多数病例在更接近足月时经阴道分娩，从而避免了不必要的剖宫产。©2023 年国际妇产科超声学会。
