P1004Diagnosis and management of fetal cardiac arrhythmias: about 100 cases

• Published in: European heart journal 2019-10, Vol.40 (Supplement_1)
• Main Authors: Messaoudi, Y, Msaad, H, Hakim, K, Ouarda, F
• Format: Article
• Language: English
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz747.0596

Abstract Background Fetal cardiac arrhythmia complicates 1–2% of pregnancies and presents a major risk of morbidity and mortality in 10% of the cases. Different questions raised by this pathology must be asked: Is it necessary to treat the rhythm disorder? What are the risks of an anti-arrhythmic treatment for the fetus and its mother? In case of failure, should the fetus be extracted at the cost of prematurity, or must the therapeutic escalation be attempted? Purpose To emphasize the primordial role of fetal echocardiography in the diagnosis and management of fetal cardiac arrhythmias through our own experience and a review of the literature. Methods We present a series of 100 cases of fetal rhythm disorders diagnosed and treated in our department of pediatric cardiology during the last 12 years. Results The diagnosis was made at an average gestational age of 30 weeks of amenorrhoea. Extra-systoles were by far the most frequent (50 cases), followed by hetero-topic tachycardia (28 cases) and complete atrio-ventricular blocks (22 cases). We have excluded bradycardia and sinus tachycardia from our study. Our attitude regarding extra-systoles was mostly a simple surveillance and the total post natal disappearance was the rule. The tachycardias were distributed as follows: 9 flutters, 16 junctional tachycardias and 3 chaotic atrial tachycardias. 10 patients were in feto-placental anasarca. The medical treatment resulted in a reduction of the in utero tachycardia in 14 cases, 9 were only post natally reduced and 6 died. Mono-therapy was the rule and dual therapy was indicated in case of resistance to medical treatment or in front of a table of foeto-placental anasarch. With a mean follow-up of 2 years, there was no recurrence. A complete atrio-ventricular block was diagnosed in 22 fetuses at an average gestational age of 26 amenorrhea weeks. 4 patients had associated heart disease. The ventricular rate varied from 35 to 70 beats per minute. 7 fetuses were in heart failure. An immunoassay was positive in 10 mothers. At birth, the presence of antibodies against SSA and/or SSB was detected in 8 newborns.15 patients were stimulated epicardially, including the neonatal period. Six patients died. Conclusion We conclude that if the prognosis of fetal tachycardia is generally satisfactory, the atrio-ventricular blocks are more reserved because the conduction disorder is irreversible, and even in the absence of associated congenital cardiopathy, complications related to