Outcomes of Sustained Fetal Tachyarrhythmias After Transplacental Treatment

Overview

Journal Heart Rhythm O2

Date 2021 Jun 11

PMID 34113918

Citations 1

Authors

Raphael Bartin

Alice Maltret

Muriel Nicloux

Yves Ville

Damien Bonnet

Julien Stirnemann

Affiliations

Soon will be listed here.

Abstract

Background: Fetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Despite a transplacental treatment, failure to obtain or maintain sinus rhythm may occur.

Objective: We aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment.

Methods: We performed a retrospective evaluation of 69 cases with sustained fetal tachyarrhythmia. We compared the perinatal and long-term outcomes of prenatally converted and drug-resistant fetuses. Tachyarrhythmia subtypes were also evaluated.

Results: Conversion to sinus rhythm was obtained in 74% of cases; 26% of cases were drug-resistant and delivered arrhythmic. Three perinatal deaths occurred in both groups (6.7% vs 17%, = .34). Neonates delivered arrhythmic were more frequently admitted to neonatal intensive care units (75% vs 31%, < .01), and their hospital stay was longer (20.9 vs 6.64 days, < .001). Multiple neonatal recurrences (81% vs 11%, < .001), temporary hemodynamic dysfunction or heart failure (50% vs 6.7%, < .001), and postnatal use of a combination treatment (44% vs 13%, = .028) were also more frequent in this population. Beyond the neonatal period, rates of recurrences within the first 16 months were higher in drug-resistant fetuses (HR = 16.14, CI 95% [4.485; 193.8], < .001). In this population, postnatal electrocardiogram revealed an overrepresentation of rare mechanisms, especially permanent junctional reciprocating tachycardia (PJRT) (31%).

Conclusion: Prenatal conversion to stable sinus rhythm is a major determinant of perinatal and long-term outcomes in fetal tachyarrhythmias. The underlying electrophysiological mechanisms have a major role in predicting these differential outcomes with an overrepresentation of PJRT in the drug-resistant population.

Citing Articles

A Rare and Challenging Case of Refractory Fetal Supraventricular Tachycardia.

Celentano L, Yoshinaga K, Shiba S, Gaynor Z, Rudolph J Cureus. 2022; 14(9):e28947.

PMID: 36225487 PMC: 9541931. DOI: 10.7759/cureus.28947.

References

Oudijk M, Ruskamp J, Ververs F, Ambachtsheer E, Stoutenbeek P, H A Visser G . Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics. J Am Coll Cardiol. 2003; 42(4):765-70. DOI: 10.1016/s0735-1097(03)00779-4. View

Miyoshi T, Maeno Y, Hamasaki T, Inamura N, Yasukochi S, Kawataki M . Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias: Multicenter Trial. J Am Coll Cardiol. 2019; 74(7):874-885. DOI: 10.1016/j.jacc.2019.06.024. View

Vigneswaran T, Callaghan N, Andrews R, Miller O, Rosenthal E, Sharland G . Correlation of maternal flecainide concentrations and therapeutic effect in fetal supraventricular tachycardia. Heart Rhythm. 2014; 11(11):2047-53. DOI: 10.1016/j.hrthm.2014.07.031. View

Sridharan S, Sullivan I, Tomek V, Wolfenden J, Skovranek J, Yates R . Flecainide versus digoxin for fetal supraventricular tachycardia: Comparison of two drug treatment protocols. Heart Rhythm. 2016; 13(9):1913-9. DOI: 10.1016/j.hrthm.2016.03.023. View

Hinkle K, Peyvandi S, Stiver C, Killen S, Weng H, Etheridge S . Postnatal Outcomes of Fetal Supraventricular Tachycardia: a Multicenter Study. Pediatr Cardiol. 2017; 38(7):1317-1323. DOI: 10.1007/s00246-017-1662-1. View

Alsaied T, Baskar S, Fares M, Alahdab F, Czosek R, Murad M . First-Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2017; 6(12). PMC: 5779032. DOI: 10.1161/JAHA.117.007164. View

Donofrio M, Moon-Grady A, Hornberger L, Copel J, Sklansky M, Abuhamad A . Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014; 129(21):2183-242. DOI: 10.1161/01.cir.0000437597.44550.5d. View

Salerno J, Kertesz N, Friedman R, Fenrich Jr A . Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children < 3 or > or =3 years of age. J Am Coll Cardiol. 2004; 43(3):438-44. DOI: 10.1016/j.jacc.2003.09.031. View

Doshi A, Mass P, Cleary K, Moak J, Funamoto K, Kimura Y . Feasibility of Non-invasive Fetal Electrocardiographic Interval Measurement in the Outpatient Clinical Setting. Pediatr Cardiol. 2019; 40(6):1175-1182. DOI: 10.1007/s00246-019-02128-w. View

10.

Southall D, Richards J, Hardwick R, Shinebourne E, Gibbens G, de Swiet M . Prospective study of fetal heart rate and rhythm patterns. Arch Dis Child. 1980; 55(7):506-11. PMC: 1626805. DOI: 10.1136/adc.55.7.506. View

11.

Carvalho J . Fetal dysrhythmias. Best Pract Res Clin Obstet Gynaecol. 2019; 58:28-41. DOI: 10.1016/j.bpobgyn.2019.01.002. View

12.

Gaita F, Montefusco A, Riccardi R, Giustetto C, Grossi S, Caruzzo E . Cryoenergy catheter ablation: a new technique for treatment of permanent junctional reciprocating tachycardia in children. J Cardiovasc Electrophysiol. 2004; 15(3):263-8. DOI: 10.1046/j.1540-8167.2004.03426.x. View

13.

Strand S, Lutter W, Strasburger J, Shah V, Baffa O, Wakai R . Low-Cost Fetal Magnetocardiography: A Comparison of Superconducting Quantum Interference Device and Optically Pumped Magnetometers. J Am Heart Assoc. 2019; 8(16):e013436. PMC: 6759914. DOI: 10.1161/JAHA.119.013436. View

14.

Stirnemann J, Maltret A, Haydar A, Stos B, Bonnet D, Ville Y . Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia. Am J Obstet Gynecol. 2018; 219(4):320-325. DOI: 10.1016/j.ajog.2018.07.018. View

15.

Bartalena L, Bogazzi F, Braverman L, Martino E . Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest. 2001; 24(2):116-30. DOI: 10.1007/BF03343825. View

16.

Strasburger J, Cuneo B, Michon M, Gotteiner N, Deal B, McGregor S . Amiodarone therapy for drug-refractory fetal tachycardia. Circulation. 2004; 109(3):375-9. DOI: 10.1161/01.CIR.0000109494.05317.58. View

17.

Kleinman C, Nehgme R . Cardiac arrhythmias in the human fetus. Pediatr Cardiol. 2004; 25(3):234-51. DOI: 10.1007/s00246-003-0589-x. View

18.

Lisowski L, Verheijen P, Benatar A, Soyeur D, Stoutenbeek P, Brenner J . Atrial flutter in the perinatal age group: diagnosis, management and outcome. J Am Coll Cardiol. 2000; 35(3):771-7. DOI: 10.1016/s0735-1097(99)00589-6. View

19.

Hornberger L, Sahn D . Rhythm abnormalities of the fetus. Heart. 2007; 93(10):1294-300. PMC: 2000955. DOI: 10.1136/hrt.2005.069369. View

20.

Naheed Z, Strasburger J, Deal B, Benson Jr D, Gidding S . Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol. 1996; 27(7):1736-40. DOI: 10.1016/0735-1097(96)00054-x. View