Mein Arzt hat heute in der 25.SSW einen Ultraschall gemacht! All rights reserved. Clues for correct diagnosis and treatment come from findings during physical examination and correct analysis of the electrocardiogram (ECG).21 Knowing the ECG features of the different types of narrow (QRS width <0.12s) or wide (QRS width >0.12s) tachycardias, it is of extreme importance to obtain ECG documentation of the arrhythmia so that the pregnant woman can receive the correct treatment. Rhythm abnormalities of the fetus. - Operation am Ungeborenen – so geht es dem Baby heute (Teil 2) - Swissfetus Anderer G, Hellmeyer L, Tekesin I, Schmidt S, Kombinationstherapie einer fetalen supraventrikulären Tachykardie mit Flecainid und Digoxin, Z Geburtshilfe Neonatol, 2005;209:34–7. It has been known for a long time that in emergencies, magnesium sulphate 1–2g IV delivered over one to two minutes is effective for treating and suppressing life-threatening ventricular tachyarrhythmias. Crosson JE, Scheel JN, Fetal arrhythmias: diagnosis, and current recommendations for therapy, Prog Pediatr Cardiol, 1996;5:141–7. 3. Ventricular tachycardia (VT) is rarely observed during pregnancy: Nakagawa et al.8 studied 11 pregnant woman who experienced new-onset ventricular arrhythmias during pregnancy. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia. Habib A, McCarthy JS, Effects on the neonate of propranolol admininstered during pregnancy, J Pediatr, 1977;91:808–11. Fetale Arrhytmien (Herzrhythmusstörungen beim Baby): Hallo Mädels, hat Jemand von euch Erfahrungen mit einer fetalen Arrhytmie, sprich bei Unregelmäßigkeiten der Herztöne beim Ungeborenen? Fetal arrhythmias are a rare but serious condition occurring in an estimated 1-2% of pregnancies. J Clin Ultrasound 16:643–650 PubMed CrossRef Google Scholar Strasburger JF, Huhta JC, Carpenter RJ, Garson A, McNama-ra DG (1986) Doppler echocardiography in the diagnosis and management of persistent fetal arrhythmias. Da hat er eine FATALE ARRHYTHMIE festgestellt! Radcliffe Cardiology is part of Radcliffe Medical Media, an independent publisher and the Radcliffe Group Ltd. Habt ihr die Diagnose bekommen und wenn ja, was waren die Konsequenzen daraus? Fetal arrhythmia was investigated in 148 fetuses. described three cases with hydrops fetalis due to supraventricular tachyarrhythmias successfully treated with amiodarone and digoxin or the combination of digoxin, procainamide and propranolol.40. The definitive diagnosis of narrow-QRS-complex tachycardia can be made in most patients based on the 12-lead ECG and clinical criteria. The goal of therapy is to protect the patient and fetus through delivery, after which chronic or definitive therapy can be administered. 2 Mongiovì M, Pipitone S. Supraventricular tachycardia in fetus: how can we treat ? Page RL, Treatment of arrhythmias during pregnancy, Am Heart J, 1995;130:871–6. Management of foetal arrhythmias is very difficult and requires co-operation between different consultants (obstetrics, cardiology, neonatology). Hansmann M, Gembruch U, Bald R, et al., Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases, Ultrasound Obstet Gynecol, 1991;1:158–60. Depending on the type of arrhythmia, hydrops fetalis, neurological sequelae and fetal demise are to be anticipated. Trappe HJ, Tchirikov M, Herzrhythmusstörungen bei der Schwangeren und beim Fetus, Internist, 2008;49:788–98. Cardosi RJ, Chez RA, Magnesium sulfate, maternal hypothermia, and fetal bradycardia with loss of heart rate variability, Obstet Gynecol, 1998;92:691–3. reported a 25- year-old pregnant woman with persistent foetal tachycardia (rate 267bpm) and subsequent hydrops fetalis.47, The woman was treated with flecainide and digoxin and tachycardia converted to sinus rhythm. Unable to process the form. These patients were compared with 52 consecutive pregnant patients referred for evaluation of symptomatic functional precordial murmur (group G II). Die intrapartale Überwachung wurde mittels Dopplersonographie vorgenommen. Pagad SV, Barmade AB, Toal SC, et al., “Rescue” radiofrequency ablation for atrial tachycardia presenting as cardiomyopathy in pregnancy, Indian Heart J, 2004;56:245–7. In pregnant women with maternal and/or foetal arrhythmias, therapeutic strategies should be based on interdisciplinary co-operation (obstetrics, cardiology, neonatology). The most common type of fetal tachycardia is supraventricular tachycardia (66–90%) followed by atrial flutter (10–30%) 12 - 15. Isolated ventricular premature beats (PVCs) were recorded in 49% of G I and 40% of G II patients (p=NS), whereas the incidence of multifocal PVCs was higher in G I (12%) than in G II patients (2%; p<0.05). However, treatment of the underlying arrhythmia requires a correct diagnosis. Where views/opinions are expressed, they are those of the author(s) and not of Radcliffe Medical Media. During pregnancy, both drugs are of limited value: sotalol appears to be relatively safe, although there is a 3–5% risk of developing polymorphic or torsade de pointes tachycardia (see Figure 3). Antiarrhythmic agents that have been used to treat foetal arrhythmias include digoxin, beta-blocking agents, verapamil, procainamide and quinidine. Allan L, Fetal arrhythmias. Of the 100 patients with atrioventricular (AV) nodal re-entrant tachycardia, one had the first onset of tachycardia during pregnancy. Fetal bradyarrhythmia refers to an abnormally low fetal heart rate (less than 100-110 beats per minute 3,7) as well as being irregular, i.e. Shotan A, Ostrzega E, Mehra A, et al., Incidence of arrhythmias in normal pregnancy and relation to palpitations, dizziness, and syncope, Am J Cardiol, 1997;79:1061–4. Walsh KA, Erzi MD, Denes P, Emergency treatment of tachyarrhythmias, Med Clin North Am, 1988;70:791–811. In patients who remain highly symptomatic, treatment with selective β-adrenergic-receptor-blocking agents should be considered. Cleary-Goldmann J, Salva CR, Infeld JI, Robinson JN, Verapamil-sensitive idiopathic left ventricular tachycardia in pregnancy, J Matern Fetal Neonatal Med, 2003;14: 132–5. In addition, umbilical drug administration allows not only direct treatment but also drug monitoring. Lee SH, Chen SA, Wu TJ, et al., Effects of pregnancy on first onset and symptoms of paroxysmal supraventricular tachycardia, Am J Cardiol, 1995;76:675–8. Sie haben zum Teil unterschiedliche Ursachen und demzufolge auch eine unterschiedliche Bedeutung und therapeutische Konsequenz There is a 1-to-1 atrioventricular conduction. Bei manchen Frauen ist es dann schier unmöglich ein vernünftiges CTG zu schreiben, weil die Herzschläge so unrhythmisch sind, dass ein CTG mit der Aufzeichnung und Auszählung (Technik halt) völlig überfordert ist. In contrast to pregnant patients with normal left ventricular function, there is a poor prognosis when VT is associated with structural heart disease.10 For acute treatment, differentiation of VT – either haemodynamically unstable or stable – is essential. Bei Aufnahme und unter der Geburt fielen schwere fetale Bradykardien auf. Navarro V, Nathan PE, Rosero H, Sacchi TJ, Accelerated idioventricular rhythm in pregnancy: a case report, Angiology, 1993;44:506–8. Wellens HJJ, Conover MB, The ECG in emergency decision making, Philadelphia, New York: WB Saunders Company, Second edition, 2006. Entezami M, Albig M, Knoll U et-al. Meine Hebamme hatte diese bei unserer … In some cases, the foetal congenital AV block is caused by QT prolongation or immune-mediated diseases.30. Lupoglazoff JM, Dejoy I, Luton D, et al., Prenatal diagnosis of a familial form of junctional ectopic tachycardia, Prenat Diagn, 1999;19:767–70. A supraventricular tachycardia is only rarely associated with intra- or extra-cardiac anomalies (in contrast to other tachyarrhythmias). Lisa Howley, Michelle Carr, Fetal Arrhythmias, Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care, 10.1007/978-1-4471-4619-3, (271-291), (2014). It is variably defined as a heart rate above 160-180 beats per minute (bpm) and typically ranges between 170-220 bpm (higher rates can occur with tachyarrhythmias). A safe combination?, Circulation, 1997;96:2808–12. Mozo de Rosales F, Moreno J, Bodegas A, et al., Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome, Eur J Obstetrics, 1994;56: 63–6. Although sustained (duration >30s) VT is rare in pregnant women, there are some reports that VT (when occurring) originates in the patient with a normal heart mainly from the right ventricular outflow tract.21 Idiopathic left VT also occurs in pregnant patients with structurally normal hearts. Of 107 patients with an accessory-pathway-mediated tachycardia, seven had the first onset of tachycardia during pregnancy. Wolbrette D, Treatment of arrhythmias during pregnancy, Curr Womens Health Rep, 2003;3:135–9. Stewart P, Wladimiroff J (1988) Fetal atrial arrhythmias associated with redundancy/aneurysm of the foramen ovale. Intrauterine death was 8.0% in foetal AFlut and 8.9% in foetal SVT (p=NS). Amiodarone is well known for its many and serious side effects for both the mother and the foetus, including hypothyroidism, growth retardation and premature delivery.40,41 There is limited experience of amiodarone during pregnancy, and treatment with this drug should be reserved for life-threatening conditions.42 Magnesium is another drug with antiarrhythmic properties, particularly in patients with torsade de pointes tachycardia due to QT prolongation. Check for errors and try again. An analysis of 11 studies reported from 1991 to 2002 showed a foetal SVT as the underlying arrhythmia in 73.2% and AFlut in 26.2%. In the event of haemodynamic embarrassment caused by AF/AFlut with rapid ventricular response, electrical DC cardioversion is usually successful with 50–100J.38 Cardioversion should always be performed in a synchronised mode. Acute therapy should start with IV procainamide or with ajmaline 50–100mg IV over five minutes. The treatment of foetal arrhythmias is possible by either treating the mother or treating the foetus directly. Although this drug is associated with few side effects, maternal hypothermia and foetal bradyarrhythmias have been observed.43 In a few cases, verapamil is effective in pregnant women with right/left ventricular outflow tachycardia.44, Life-threatening VF or VFlut can occur at any stage of pregnancy and is associated with a high risk of sudden cardiac death. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. A case report of treatment with propranolol hydrochloride, Fetal Diagn Ther, 2003;18: 463–6. Copel JA, Kleiman CS, Fetal echocardiography in the diagnosis and management of fetal heart disease, Clin Diagn Ultrasound, 1989;25:67–83. fetal supraventricular tachycardia (SVT) most common fetal tachyarrhythmia: accounts for 60-90% of cases; has a typical ventricular rate of ~230-280 beats per minute (bpm) 4; often associated with an accessory AV conduction pathway; fetal atrial flutter. Ultrasound Diagnosis of Fetal Anomalies. Neonaten von Müttern mit OSAS zählen die vorzeitige Geburt, häufigere Entbindung per Sectio caesarea, ein niedriges bzw. It is possible to determine the atrial rate using M-mode echocardiography, while the ventricular rate is determined with the use of M-mode and/or echo-Doppler. Pathology. The advantage of adenosine 9–18mg intravenous (IV) as bolus relative to intravenous calcium antagonists or beta-blockers relates to its rapidity of onset and short half-life.34 In addition, the current reported human clinical experience with adenosine during pregnancy indicates no teratogenicity or other adverse effects to the foetus, and it is as effective in terminating SVT (efficacy rates >90%) in pregnant woman as it is in patients who are not pregnant. Hornberger LK, Sahn DJ. In contrast, β2-blocking agents are associated in some cases with reduced utero–placental perfusion and/or foetal growth retardation, and should not be chosen for treating VPBs.39 There is no indication for treatment with class III antiarrhythmic drugs due to their side effects and the associated risk of proarrhythmia.14. Their diagnosis is important in the fetal stage as it might help provide an opportunity to plan and manage the baby as and when the baby is born. Premium Drupal Theme by However, IV administration of verapamil carries a risk of precipitating maternal hypotension and secondary hypoperfusion. Bei allen Patientinnen wurde die fetale Herzaktivität ultrasonografisch and mittels Abdominal-EKG oszilloscopisch sichtbar gemacht und auf Magnetband aufgenommen. There are several possible mechanisms of wide-QRS-complex tachycardia. Fetal echocardiography, or Fetal echocardiogram, is the name of the test used to diagnose cardiac conditions in the fetal stage.Cardiac defects are amongst the most common birth defects. Hrsg. In about 10% of those cases, morbidity or even mortality occurs. Therefore, ajmalin should be avoided during the first trimester and used only when other therapeutic alternatives are not present or even unsuccessful. Des. In patients with VF or VFlut, DC defibrillation is the treatment method of choice (100–360J). J Ultrasound Med. Antwort: Arrhythmie beim Ungeborenen. Fetal supraventricular tachycardia (SVT) is considered the most common type of fetal tachyarrhythmia and can account for 60-90% of such cases. The heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia, and a heart rate that is too slow – below 60 beats per minute – is called bradycardia. Fetal atrial flutter is the second most common fetal tachyarrhythmia and can account for up to 30% of such cases 1,2. Bravermann AC, Bromley BS, Rutherford JD, New onset ventricular tachycardia during pregnancy, Int J Cardiol, 1991;33:409–12. If at any time VT becomes unstable or there is evidence of foetal compromise, DC countershock (50–100J) should be delivered immediately (see Figure 1). Schauen Sie sich jetzt die ganze Liste der weiteren möglichen Ursachen und Krankheiten an! Fetal supraventricular tachycardia (SVT). Tan HL, Lie KI, Treatment of tachyarrhythmias during pregnancy and lactation, Eur Heart J, 2001;22:458–64. Widerhorn J, Widerhorn ALM, Rahimtoola SH, Elkayam U, WPW syndrome during pregnancy: increased incidence of supraventricular arrhythmias, Am Heart J, 1992;123:796–8.