Killen Stacy A S, Strasburger Janette F
Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN 37232, USA.
Division of Cardiology, Departments of Pediatrics and Biomedical Engineering, Children's Wisconsin, Herma Heart Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Cardiovasc Dev Dis. 2024 May 24;11(6):163. doi: 10.3390/jcdd11060163.
Diagnosis and management of fetal arrhythmias have changed over the past 40-50 years since propranolol was first used to treat fetal tachycardia in 1975 and when first attempts were made at in utero pacing for complete heart block in 1986. Ongoing clinical trials, including the FAST therapy trial for fetal tachycardia and the STOP-BLOQ trial for anti-Ro-mediated fetal heart block, are working to improve diagnosis and management of fetal arrhythmias for both mother and fetus. We are also learning more about how "silent arrhythmias", like long QT syndrome and other inherited channelopathies, may be identified by recognizing "subtle" abnormalities in fetal heart rate, and while echocardiography yet remains the primary tool for diagnosing fetal arrhythmias, research efforts continue to advance the clinical envelope for fetal electrocardiography and fetal magnetocardiography. Pharmacologic management of fetal arrhythmias remains one of the most successful achievements of fetal intervention. Patience, vigilance, and multidisciplinary collaboration are key to successful diagnosis and treatment.
自1975年首次使用普萘洛尔治疗胎儿心动过速以及1986年首次尝试在子宫内起搏治疗完全性心脏传导阻滞以来，胎儿心律失常的诊断和管理在过去40至50年中发生了变化。正在进行的临床试验，包括针对胎儿心动过速的FAST治疗试验和针对抗Ro介导的胎儿心脏传导阻滞的STOP - BLOQ试验，致力于改善对母亲和胎儿的胎儿心律失常的诊断和管理。我们也在更多地了解如何通过识别胎儿心率的“细微”异常来发现“隐匿性心律失常”，如长QT综合征和其他遗传性离子通道病，并且虽然超声心动图仍然是诊断胎儿心律失常的主要工具，但研究工作仍在不断拓展胎儿心电图和胎儿磁心动图的临床应用范围。胎儿心律失常的药物治疗仍然是胎儿干预最成功的成果之一。耐心、警惕和多学科协作是成功诊断和治疗的关键。
