Tsokkou Sophia, Konstantinidis Ioannis, Anastasiou Vasileios, Matsas Alkis, Stamoula Eleni, Peteinidou Emmanuela, Sioga Antonia, Papamitsou Theodora, Ziakas Antonios, Kamperidis Vasileios
1st Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Laboratory of Histology-Embryology, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
J Pers Med. 2025 Aug 1;15(8):341. doi: 10.3390/jpm15080341.
Fetal tachyarrhythmias, particularly supraventricular tachycardia (SVT) and atrial flutter (AFL), pose significant clinical challenges, especially when complicated by hydrops fetalis. This article provides a comprehensive review of the tachyarrhythmia types, the diagnostic modalities applied, and the therapeutic strategies followed in fetal tachyarrhythmias. Diagnostic techniques such as M-mode echocardiography and fetal magnetocardiography (fMCG) are highlighted for their capacity to provide real-time, high-quality assessments of fetal cardiac rhythms. The review, also, focuses on pharmacologic management via transplacental therapy, discussing the safety and efficacy of the key agents including digoxin, flecainide, and sotalol, under different clinical scenarios, such as hydropic fetus and renal impairment. In addition to transplacental administration, alternative approaches such as direct fetal intramuscular or intravascular injections are examined. These direct methods, while potentially more effective in refractory cases, carry risks that necessitate specialized expertise and careful consideration of maternal and fetal safety. The limitations of current evidence, largely based on small case studies and retrospective analyses, underscore the need for larger, prospective multicenter observational studies and randomized control trials to establish standardized protocols for fetal tachyarrhythmia management. Overall, this review advocates for a personalized, multidisciplinary approach, emphasizing early fetal tachyarrhythmias diagnosis, tailored treatment regimens that balances efficacy with safety, and rigorous monitoring to optimize outcomes for both the fetus and the mother.
胎儿心律失常，尤其是室上性心动过速（SVT）和心房扑动（AFL），带来了重大的临床挑战，尤其是当合并胎儿水肿时。本文全面综述了胎儿心律失常的类型、应用的诊断方法以及遵循的治疗策略。重点介绍了诸如M型超声心动图和胎儿心磁图（fMCG）等诊断技术，因其能够对胎儿心律进行实时、高质量的评估。该综述还聚焦于经胎盘治疗的药物管理，讨论了地高辛、氟卡尼和索他洛尔等关键药物在不同临床场景（如水肿胎儿和肾功能损害）下的安全性和有效性。除了经胎盘给药外，还研究了直接胎儿肌肉注射或血管内注射等替代方法。这些直接方法虽然在难治性病例中可能更有效，但存在风险，需要专业知识并仔细考虑母婴安全。目前的证据大多基于小病例研究和回顾性分析，其局限性凸显了开展更大规模的前瞻性多中心观察性研究和随机对照试验以建立胎儿心律失常管理标准化方案的必要性。总体而言，本综述提倡采用个性化的多学科方法，强调早期诊断胎儿心律失常、制定平衡疗效与安全性的个性化治疗方案以及进行严格监测以优化胎儿和母亲的结局。
