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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 |
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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&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. The proposed management protocol has so far yielded a good rate of conversion to sinus rhythm.</description><subject>AET</subject><subject>Anti-Arrhythmia Agents - therapeutic use</subject><subject>arrhythmia</subject><subject>ascending aorta</subject><subject>atrial ectopic tachycardia</subject><subject>atrioventricular</subject><subject>Biological and medical sciences</subject><subject>Blood Flow Velocity</subject><subject>Cardiac arrhythmia</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. 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 & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Science Journals</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fouron, J-C</au><au>Fournier, A</au><au>Proulx, F</au><au>Lamarche, J</au><au>Bigras, J L</au><au>Boutin, C</au><au>Brassard, M</au><au>Gamache, S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings</atitle><jtitle>British heart journal</jtitle><addtitle>Heart</addtitle><date>2003-10-01</date><risdate>2003</risdate><volume>89</volume><issue>10</issue><spage>1211</spage><epage>1216</epage><pages>1211-1216</pages><issn>1355-6037</issn><issn>0007-0769</issn><eissn>1468-201X</eissn><abstract>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.</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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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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