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Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings

Objective: To evaluate a management protocol of fetal supraventricular tachycardia (SVT) based on prior identification of the underlying mechanism. Design and setting: Prospective study in a mother–child tertiary university centre. Patients: During a consecutive 36 month period, 18 fetuses with sust...

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Published in:British heart journal 2003-10, Vol.89 (10), p.1211-1216
Main Authors: Fouron, J-C, Fournier, A, Proulx, F, Lamarche, J, Bigras, J L, Boutin, C, Brassard, M, Gamache, S
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container_issue 10
container_start_page 1211
container_title British heart journal
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creator Fouron, J-C
Fournier, A
Proulx, F
Lamarche, J
Bigras, J L
Boutin, C
Brassard, M
Gamache, S
description Objective: To evaluate a management protocol of fetal supraventricular tachycardia (SVT) based on prior identification of the underlying mechanism. Design and setting: Prospective study in a mother–child tertiary university centre. Patients: During a consecutive 36 month period, 18 fetuses with sustained SVT underwent a superior vena cava/ascending aorta (SVC/AA) Doppler investigation in an attempt to determine the atrioventricular (AV) relation and to treat the arrhythmia according to a pre-established management protocol. Main outcome measure: Rate of conversion to sinus rhythm. Results: Seven fetuses had short ventriculoatrial tachycardia, five of these with a 1:1 AV conduction suggesting re-entrant tachycardia. The first choice drug was digoxin and all were converted. One fetus had AV dissociation leading to the diagnosis of junctional ectopic tachycardia, which was resistant to digoxin and sotalol; amiodarone achieved postnatal conversion. One fetus had SVT and first or second AV block; the diagnosis was atrial ectopic tachycardia (AET), which responded to sotalol given as a drug of first choice. Seven fetuses had long ventriculoatrial tachycardia: one with sinus tachycardia (no treatment), one with permanent junctional reciprocating tachycardia (PJRT), and three with AET. The first choice drug was sotalol and all were converted. One AET was classified postnatally as PJRT. Six fetuses had intra-atrial re-entrant tachycardia: five with 2:1 AV conduction and one with variable block. The first choice drug was digoxin. Conversion was achieved in all but one, who died after birth from advanced cardiomyopathy. Conclusion: The electrophysiological mechanisms of fetal SVT can be clarified with SVC/AA Doppler. The proposed management protocol has so far yielded a good rate of conversion to sinus rhythm.
doi_str_mv 10.1136/heart.89.10.1211
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Design and setting: Prospective study in a mother–child tertiary university centre. Patients: During a consecutive 36 month period, 18 fetuses with sustained SVT underwent a superior vena cava/ascending aorta (SVC/AA) Doppler investigation in an attempt to determine the atrioventricular (AV) relation and to treat the arrhythmia according to a pre-established management protocol. Main outcome measure: Rate of conversion to sinus rhythm. Results: Seven fetuses had short ventriculoatrial tachycardia, five of these with a 1:1 AV conduction suggesting re-entrant tachycardia. The first choice drug was digoxin and all were converted. One fetus had AV dissociation leading to the diagnosis of junctional ectopic tachycardia, which was resistant to digoxin and sotalol; amiodarone achieved postnatal conversion. One fetus had SVT and first or second AV block; the diagnosis was atrial ectopic tachycardia (AET), which responded to sotalol given as a drug of first choice. Seven fetuses had long ventriculoatrial tachycardia: one with sinus tachycardia (no treatment), one with permanent junctional reciprocating tachycardia (PJRT), and three with AET. The first choice drug was sotalol and all were converted. One AET was classified postnatally as PJRT. Six fetuses had intra-atrial re-entrant tachycardia: five with 2:1 AV conduction and one with variable block. The first choice drug was digoxin. Conversion was achieved in all but one, who died after birth from advanced cardiomyopathy. Conclusion: The electrophysiological mechanisms of fetal SVT can be clarified with SVC/AA Doppler. The proposed management protocol has so far yielded a good rate of conversion to sinus rhythm.</description><identifier>ISSN: 1355-6037</identifier><identifier>ISSN: 0007-0769</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heart.89.10.1211</identifier><identifier>PMID: 12975422</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>AET ; Anti-Arrhythmia Agents - therapeutic use ; arrhythmia ; ascending aorta ; atrial ectopic tachycardia ; atrioventricular ; Biological and medical sciences ; Blood Flow Velocity ; Cardiac arrhythmia ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Cardiomyopathy ; Congenital Heart Disease ; Coronary vessels ; digoxin ; Diseases ; Doppler echocardiography ; Drug dosages ; Echocardiography, Doppler - methods ; Echocardiography, Doppler, Pulsed - methods ; Electrocardiography ; Female ; Fetal Diseases - diagnostic imaging ; Fetal Diseases - drug therapy ; Fetal Diseases - physiopathology ; Fetal heart ; fetal tachycardia ; Fetuses ; Gestational Age ; Heart ; Heart rate ; Humans ; Infant, Newborn ; Management ; Medical sciences ; Methods ; permanent junctional reciprocating tachycardia ; PJRT ; Postnatal Care ; Pregnancy ; Prenatal Care - methods ; Prospective Studies ; Sinuses ; sotalol ; Statistics ; Substance abuse treatment ; superior vena cava ; supraventricular tachycardia ; SVC ; SVT ; Tachycardia ; Tachycardia, Supraventricular - diagnostic imaging ; Tachycardia, Supraventricular - drug therapy ; Tachycardia, Supraventricular - physiopathology ; Treatment Outcome ; Ultrasonography, Prenatal - methods ; VA intervals ; ventriculoatrial</subject><ispartof>British heart journal, 2003-10, Vol.89 (10), p.1211-1216</ispartof><rights>Copyright 2003 by Heart</rights><rights>2004 INIST-CNRS</rights><rights>COPYRIGHT 2003 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2003 Copyright 2003 by Heart</rights><rights>Copyright © Copyright 2003 by Heart 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b601t-7d87fbc4a8f81f4485d4bcec974ed386daf15f04ba5ddb2b14f7125c60ad6c913</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767897/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767897/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=15158816$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12975422$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fouron, J-C</creatorcontrib><creatorcontrib>Fournier, A</creatorcontrib><creatorcontrib>Proulx, F</creatorcontrib><creatorcontrib>Lamarche, J</creatorcontrib><creatorcontrib>Bigras, J L</creatorcontrib><creatorcontrib>Boutin, C</creatorcontrib><creatorcontrib>Brassard, M</creatorcontrib><creatorcontrib>Gamache, S</creatorcontrib><title>Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings</title><title>British heart journal</title><addtitle>Heart</addtitle><description>Objective: To evaluate a management protocol of fetal supraventricular tachycardia (SVT) based on prior identification of the underlying mechanism. Design and setting: Prospective study in a mother–child tertiary university centre. Patients: During a consecutive 36 month period, 18 fetuses with sustained SVT underwent a superior vena cava/ascending aorta (SVC/AA) Doppler investigation in an attempt to determine the atrioventricular (AV) relation and to treat the arrhythmia according to a pre-established management protocol. Main outcome measure: Rate of conversion to sinus rhythm. Results: Seven fetuses had short ventriculoatrial tachycardia, five of these with a 1:1 AV conduction suggesting re-entrant tachycardia. The first choice drug was digoxin and all were converted. One fetus had AV dissociation leading to the diagnosis of junctional ectopic tachycardia, which was resistant to digoxin and sotalol; amiodarone achieved postnatal conversion. One fetus had SVT and first or second AV block; the diagnosis was atrial ectopic tachycardia (AET), which responded to sotalol given as a drug of first choice. Seven fetuses had long ventriculoatrial tachycardia: one with sinus tachycardia (no treatment), one with permanent junctional reciprocating tachycardia (PJRT), and three with AET. The first choice drug was sotalol and all were converted. One AET was classified postnatally as PJRT. Six fetuses had intra-atrial re-entrant tachycardia: five with 2:1 AV conduction and one with variable block. The first choice drug was digoxin. Conversion was achieved in all but one, who died after birth from advanced cardiomyopathy. Conclusion: The electrophysiological mechanisms of fetal SVT can be clarified with SVC/AA Doppler. 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Vascular system</subject><subject>Cardiomyopathy</subject><subject>Congenital Heart Disease</subject><subject>Coronary vessels</subject><subject>digoxin</subject><subject>Diseases</subject><subject>Doppler echocardiography</subject><subject>Drug dosages</subject><subject>Echocardiography, Doppler - methods</subject><subject>Echocardiography, Doppler, Pulsed - methods</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fetal Diseases - diagnostic imaging</subject><subject>Fetal Diseases - drug therapy</subject><subject>Fetal Diseases - physiopathology</subject><subject>Fetal heart</subject><subject>fetal tachycardia</subject><subject>Fetuses</subject><subject>Gestational Age</subject><subject>Heart</subject><subject>Heart rate</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Management</subject><subject>Medical sciences</subject><subject>Methods</subject><subject>permanent junctional reciprocating tachycardia</subject><subject>PJRT</subject><subject>Postnatal Care</subject><subject>Pregnancy</subject><subject>Prenatal Care - methods</subject><subject>Prospective Studies</subject><subject>Sinuses</subject><subject>sotalol</subject><subject>Statistics</subject><subject>Substance abuse treatment</subject><subject>superior vena cava</subject><subject>supraventricular tachycardia</subject><subject>SVC</subject><subject>SVT</subject><subject>Tachycardia</subject><subject>Tachycardia, Supraventricular - diagnostic imaging</subject><subject>Tachycardia, Supraventricular - drug therapy</subject><subject>Tachycardia, Supraventricular - physiopathology</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Prenatal - methods</subject><subject>VA intervals</subject><subject>ventriculoatrial</subject><issn>1355-6037</issn><issn>0007-0769</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNqFktuLEzEUxgdR3HX13ScJiL7IdJOZ3OZFWKurwnrDC75IOJNJ2tSZpCbTav97023ZqixIHhJOfuc7-cJXFPcJnhBS89O5gThOZDPZFipCbhTHhHJZVph8vZnPNWMlx7U4Ku6ktMAY00by28URqRrBaFUdF9_egIeZGYwfUbDImhF6NIKebyDG-WacDw5QC8l0KHiUVksTXYhobTwgDWs4hRBHQM_DctmbiGwffqJodIid87N0t7hloU_m3n4_KT6fv_g0fVVevHv5enp2UbYck7EUnRS21RSklcRSKllHW210I6jpask7sIRZTFtgXddWLaFWkIppjqHjuiH1SfF0p7tctYPpdHYToVfL6AaIGxXAqb9vvJurWVgrIriQjcgCj_cCMfxYmTSqwSVt-h68CaukRM1pw-kWfPgPuAir6LO5rCWxaISQLFPljppBb5TzNuSpema8ycODN9bl8hnBMsOilpmfXMPn1ZnB6Wsb8K5Bx5BSNPbKK8FqGw11GQ0lm8tCjkZuefDnHx0a9lnIwKM9AElDbyN47dKBY4RJSfjBnEuj-XV1D_G74qIWTL39MlXvRXX-rGIf1MfMP9nx7bD4_zN_A-m-4T0</recordid><startdate>20031001</startdate><enddate>20031001</enddate><creator>Fouron, J-C</creator><creator>Fournier, A</creator><creator>Proulx, F</creator><creator>Lamarche, J</creator><creator>Bigras, J L</creator><creator>Boutin, C</creator><creator>Brassard, M</creator><creator>Gamache, S</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>Copyright 2003 by Heart</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20031001</creationdate><title>Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings</title><author>Fouron, J-C ; Fournier, A ; Proulx, F ; Lamarche, J ; Bigras, J L ; Boutin, C ; Brassard, M ; Gamache, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b601t-7d87fbc4a8f81f4485d4bcec974ed386daf15f04ba5ddb2b14f7125c60ad6c913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>AET</topic><topic>Anti-Arrhythmia Agents - therapeutic use</topic><topic>arrhythmia</topic><topic>ascending aorta</topic><topic>atrial ectopic tachycardia</topic><topic>atrioventricular</topic><topic>Biological and medical sciences</topic><topic>Blood Flow Velocity</topic><topic>Cardiac arrhythmia</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathy</topic><topic>Congenital Heart Disease</topic><topic>Coronary vessels</topic><topic>digoxin</topic><topic>Diseases</topic><topic>Doppler echocardiography</topic><topic>Drug dosages</topic><topic>Echocardiography, Doppler - methods</topic><topic>Echocardiography, Doppler, Pulsed - methods</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fetal Diseases - diagnostic imaging</topic><topic>Fetal Diseases - drug therapy</topic><topic>Fetal Diseases - physiopathology</topic><topic>Fetal heart</topic><topic>fetal tachycardia</topic><topic>Fetuses</topic><topic>Gestational Age</topic><topic>Heart</topic><topic>Heart rate</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Management</topic><topic>Medical sciences</topic><topic>Methods</topic><topic>permanent junctional reciprocating tachycardia</topic><topic>PJRT</topic><topic>Postnatal Care</topic><topic>Pregnancy</topic><topic>Prenatal Care - methods</topic><topic>Prospective Studies</topic><topic>Sinuses</topic><topic>sotalol</topic><topic>Statistics</topic><topic>Substance abuse treatment</topic><topic>superior vena cava</topic><topic>supraventricular tachycardia</topic><topic>SVC</topic><topic>SVT</topic><topic>Tachycardia</topic><topic>Tachycardia, Supraventricular - diagnostic imaging</topic><topic>Tachycardia, Supraventricular - drug therapy</topic><topic>Tachycardia, Supraventricular - physiopathology</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Prenatal - methods</topic><topic>VA intervals</topic><topic>ventriculoatrial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fouron, J-C</creatorcontrib><creatorcontrib>Fournier, A</creatorcontrib><creatorcontrib>Proulx, F</creatorcontrib><creatorcontrib>Lamarche, J</creatorcontrib><creatorcontrib>Bigras, J L</creatorcontrib><creatorcontrib>Boutin, C</creatorcontrib><creatorcontrib>Brassard, M</creatorcontrib><creatorcontrib>Gamache, S</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest_Health &amp; 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Design and setting: Prospective study in a mother–child tertiary university centre. Patients: During a consecutive 36 month period, 18 fetuses with sustained SVT underwent a superior vena cava/ascending aorta (SVC/AA) Doppler investigation in an attempt to determine the atrioventricular (AV) relation and to treat the arrhythmia according to a pre-established management protocol. Main outcome measure: Rate of conversion to sinus rhythm. Results: Seven fetuses had short ventriculoatrial tachycardia, five of these with a 1:1 AV conduction suggesting re-entrant tachycardia. The first choice drug was digoxin and all were converted. One fetus had AV dissociation leading to the diagnosis of junctional ectopic tachycardia, which was resistant to digoxin and sotalol; amiodarone achieved postnatal conversion. One fetus had SVT and first or second AV block; the diagnosis was atrial ectopic tachycardia (AET), which responded to sotalol given as a drug of first choice. Seven fetuses had long ventriculoatrial tachycardia: one with sinus tachycardia (no treatment), one with permanent junctional reciprocating tachycardia (PJRT), and three with AET. The first choice drug was sotalol and all were converted. One AET was classified postnatally as PJRT. Six fetuses had intra-atrial re-entrant tachycardia: five with 2:1 AV conduction and one with variable block. The first choice drug was digoxin. Conversion was achieved in all but one, who died after birth from advanced cardiomyopathy. Conclusion: The electrophysiological mechanisms of fetal SVT can be clarified with SVC/AA Doppler. The proposed management protocol has so far yielded a good rate of conversion to sinus rhythm.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>12975422</pmid><doi>10.1136/heart.89.10.1211</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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ispartof British heart journal, 2003-10, Vol.89 (10), p.1211-1216
issn 1355-6037
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1468-201X
language eng
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subjects AET
Anti-Arrhythmia Agents - therapeutic use
arrhythmia
ascending aorta
atrial ectopic tachycardia
atrioventricular
Biological and medical sciences
Blood Flow Velocity
Cardiac arrhythmia
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiomyopathy
Congenital Heart Disease
Coronary vessels
digoxin
Diseases
Doppler echocardiography
Drug dosages
Echocardiography, Doppler - methods
Echocardiography, Doppler, Pulsed - methods
Electrocardiography
Female
Fetal Diseases - diagnostic imaging
Fetal Diseases - drug therapy
Fetal Diseases - physiopathology
Fetal heart
fetal tachycardia
Fetuses
Gestational Age
Heart
Heart rate
Humans
Infant, Newborn
Management
Medical sciences
Methods
permanent junctional reciprocating tachycardia
PJRT
Postnatal Care
Pregnancy
Prenatal Care - methods
Prospective Studies
Sinuses
sotalol
Statistics
Substance abuse treatment
superior vena cava
supraventricular tachycardia
SVC
SVT
Tachycardia
Tachycardia, Supraventricular - diagnostic imaging
Tachycardia, Supraventricular - drug therapy
Tachycardia, Supraventricular - physiopathology
Treatment Outcome
Ultrasonography, Prenatal - methods
VA intervals
ventriculoatrial
title Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings
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