Fetal Atrial Tachyarrhythmia - A Case Report, Treatment and Outcome

Dr. Vera Stankovikj*, Dr. Adam Fitzpatrick**
Institute of Cardiovascular Sciences, University of Manchester, UK*, Department of Cardiology, Central Manchester NHS Foundation Hospitals Trust, Manchester, UK**
Fetal tachyarrhythmia is a rare disorder characterized by fetal heart rates that exceed 180 bpm. Fetal echocardiography is considered a gold standard for confirming the diagnosis. Fetal atrial flutter and atrial tachycardia are the most commonly encountered arrhythmias. These may cause fetal hydrops and lead to fetal morbidity and mortality.
We present a case of a 4-year-old child with atrial tachyarrhythmia diagnosed during pregnancy.
Case Report
A 35-year-old pregnant woman was diagnosed with fetal atrial tachyarrhythmia at gestational age 30 weeks, characterized by atrial and ventricular rates of ~450bpm and ~150bpm respectively. Intrauterine treatment with Digoxin was initiated. The arrhythmia persisted in utero and in the newborn upon delivery. Initial echocardiography revealed no structural abnormalities. Multiple direct current cardio-versions were performed early postnatally but none restored sinus rhythm. The arrhythmia was resistant to drugs. Only intravenous Flecainide restored sinus rhythm transiently. Oral Flecainide and Propanol were ineffective, and the patient eventually received Amiodarone. This achieved good rate control, but did not terminate the arrhythmia. Throughout pregnancy, postnatal care and over 4 years of follow-up no ill-effects of the tachycardia were noted. Various arrhythmias were noted during this time, including: atrial tachycardia, multi-focal atrial tachycardia and atypical atrial flutter. The patient is currently 4 years old, haemodynamically stable and regularly monitored for Amiodarone toxicity.
Long-term continuation of in utero atrial tachyarrhythmias is a rare clinical phenomenon. In this instance, there were apparently no ill-effects, and it may be that Amiodarone treatment will turn out to be worse than the illness. Elucidation of the exact underlying electrophysiological mechanism is usually of value for selecting the most appropriate treatment strategy, but was unhelpful here. Understanding why some fetal arrhythmias are so dangerous and others seem to be well-tolerated is a challenge.
How to Cite URL :
Stankovikj V D, Fitzpatrick A D.. Available From : http://www.pediatriconcall.com/conference/abstract/36/view/848
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