Fetal arrhythmias present as an irregular cardiac rhythm and abnormal heart rate. Despite the theoretical advantage of fetoplacental circulation, rapid progression to hydrops is found in fetuses with tachyarrhythmia or bradyarrhythmia due to the limited heart rate reserve. Accurate diagnosis is essential for appropriate management of fetal arrhythmias, but this can be challenging since fetal electrocardiography is unavailable. Echocardiography plays a pivotal role in diagnosis and management of fetal arrhythmias. Most cases of fetal arrhythmia have a structurally normal heart with isolated premature contractions that often spontaneously resolve without medical treatment. There is a clear clinical consensus that maternal transplacental antiarrhythmic therapy for fetal tachyarrhythmia is effective. Complete atrioventricular block is irreversible. Dexamethasone and intravenous immunoglobulin have been used to prevent myocardial inflammation, but recent studies have not shown efficacy of these drugs for fetal bradyarrhythmias. Long QT syndrome manifests in several heart rate patterns and is associated with cardiac arrest and sudden death. Maternal intravenous magnesium is effective for ventricular tachycardia or torsades de pointes. This chapter reviews the different types of fetal arrhythmias and gives an overview of the current diagnostic techniques and treatment strategies.
KeywordsBradycardia Fetal arrhythmia Fetal treatment Prenatal diagnosis Tachycardia
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