Tek Merkezde Yapılan Bölgesel Fetal Aritmi Tarama Sonuçları ve Postnatal Takip Güncel Sonuçları

Amaçlar Fetal aritmiler gebelikte karşılaşılan önemli hastalıklardan birisidir ve fetal iyilik halini belirleyen önemli bir sağlık sorunudur. Bu çalışma bu bozuklukların tanı yöntemlerini, tedavi planlarını ve prognozunu değerlendirmeyi amaçlamaktadır. Metodlar Bu çalışmada Ocak 2018-Ocak 2021 yılları arasında fetal aritmi tanısı alan 28 fetusun kayıtları retrospektif olarak değerlendirilmiştir. Sonuç 1254 gebe kadının 28'inde (%2,2) fetal aritmi tespit edildi. Hastaların 21/28'inde (%75) düzensiz ritim, 4/28'inde (%14,2) supraventriküler taşikardi, 3/28'inde (%10,7) fetal av blok görüldü. Fetusta taşikardisi olan tüm gebeler hastaneye yatırılarak uygun dozda digoksin başlandı. Atriyal taşikardi/fibriloflutter olan ¼ fetusta ; sotalol eklendi ve kombine tedaviye başlandı. İnatçı taşikardisi olan diğer fetüse ise hız kontrolü sağlamak amacıyla sotalol de eklendi. Atriyal fibriloflutter olan yenidoğana doğumda kardiyoversiyon uygulandı. Bu yenidoğana propafenon propranolol amiodaron üçlü kombinasyonu başlanarak taşikardi kontrol altına alındı. Taşikardisi olan hastalarda intrauterin ölüm ve postnatal dönemde mortalite görülmedi. Bir hastada doğumdan sonra WPW sendromu tespit edildi. WPW sendromu ve atriyal fibriloflutter hastaların da en az iki yıl uzun süreli medikal tedavi planlandı. AV tam bloklu ve kompleks konjenital kalp hastalığı olan 2 fetüs intrauterin dönemde kaybedildi. Diğer AV blok olan fetüsün neonatal lupusu vardı ve doğum sonrası dönemde kalp yetmezliği nedeniyle kaybedildi. Tartışma Fetal ekokardiyografi Doppler yaklaşımı ile fetal kalp ritim bozuklukları doğum öncesi dönemde tespit edilebilmektedir. Fetüsün sağlık durumuna göre antiaritmik ilaçlar düşünülebilir. Etiyolojinin aydınlatılmasında annenin diyeti ve lupus antikorları dikkate alınmalıdır.

Anahtar Kelimeler:

Fetal aritmi, fetal ekokardiyografi, prenatal tanı, fetal taşikardi.

Regional Fetal Arrhythmia Screening Results and Postnatal Follow-up Current Results In a Single Center

Background/Aims Fetal arrhythmias are one of the challenging diseases in pregnancies and have an important impress on fetal health. This study aims to evaluate diagnosis methods, treatment plans, and prognosis for these disorders. Methods Fetuses diagnosed with fetal arrhythmia between January 2018 and January 2021 were retrospectively screened from hospital records and 28 fetuses were identified. Results Fetal arrhythmia was detected in 28 fetuses out of 1254 pregnant women (2.2%). Irregular rhythm was observed in 21/28(75%) of the fetuses, supraventricular tachycardia in 4/28 fetuses (14.2%), and fetal atrioventricular(AV) block in 3/28 fetuses (10.7%). All fetuses with tachycardia were hospitalized and digoxin was started at the appropriate dose. In 1/4 of fetuses with atrial tachycardia/fibriloflutter; sotalol was added and combined treatment was started. In the other fetus with persistent tachycardia, sotalol was also added to achieve the rate control. Cardioversion was applied to the newborn who had atrial fibriloflutter at birth. In this newborn, a propafenone propranolol amiodarone triple combination was started and tachycardia was controlled. There was neither intrauterine death nor mortality in the postnatal period in patients with tachycardia. WPW syndrome was detected in one patient after birth. Prolonged medical treatment for at least two years is planned in patients with WPW syndrome and atrial fibriloflutter.2 fetuses with complete AV block and complex congenital heart diseases had died in the intrauterine period. The other fetus with AV block had neonatal lupus and this patient also died due to heart failure in the postnatal period. Conclusions Fetal heart rhythm disorders can be detected prenatally with fetal echocardiography Doppler approach. Anti-arrhythmic drugs could be considered depending on the fetuses’ well-being. The mother's diet, and lupus antibodies should be considered in elucidating the etiology.

Keywords:

Fetal arrhythmias, fetal echocardiography, prenatal diagnosis, fetal tachycardia,

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1. Macones GA, Hankins GD, Spong CY, Hauth J, Moore T. The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines. Obstet Gynecol. 2008;112(3):661-6.
2. Shenker L. Fetal cardiac arrhythmias. Obstet Gynecol Surv. 1979;34(8):561-72.
3. Fouron JC. Fetal arrhythmias: the Saint-Justine hospital experience. Prenat Diagn. 2004;24(13):1068-80.
4. Jaeggi E, Öhman A. Fetal and Neonatal Arrhythmias. Clinics in Perinatology. 2016;43(1):99-112.
5. Vergani P, Mariani E, Ciriello E, Locatelli A, Strobelt N, Galli M, et al. Fetal arrhythmias: natural history and management. Ultrasound Med Biol. 2005;31(1):1-6.
6. Boldt T, Eronen M, Andersson S. Long-term outcome in fetuses with cardiac arrhythmias. Obstet Gynecol. 2003;102(6):1372-9.
7. van Engelen AD, Weijtens O, Brenner JI, Kleinman CS, Copel JA, Stoutenbeek P, et al. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol. 1994;24(5):1371-5.
8. Simpson JM, Milburn A, Yates RW, Maxwell DJ, Sharland GK. Outcome of intermittent tachyarrhythmias in the fetus. Pediatr Cardiol. 1997;18(2):78-82.
9. Api O, Carvalho JS. Fetal dysrhythmias. Best Pract Res Clin Obstet Gynaecol. 2008;22(1):31-48.
10. Cameron AD, Walker JJ, Nimrod CA. Fetal tachycardias. Bmj. 1988;297(6648):623.
11. Oudijk MA, Ruskamp JM, Ambachtsheer BE, Ververs TF, Stoutenbeek P, Visser GH, et al. Drug treatment of fetal tachycardias. Paediatr Drugs. 2002;4(1):49-63.
12. Ramlakhan KP, Kauling RM, Schenkelaars N, Segers D, Yap SC, Post MC, et al. Supraventricular arrhythmia in pregnancy. Heart. 2022;108(21):1674-81.
13. Simpson LL. Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol. 2000;24(5):360-72.
14. Wacker-Gussmann A, Strasburger JF, Cuneo BF, Wakai RT. Diagnosis and treatment of fetal arrhythmia. Am J Perinatol. 2014;31(7):617-28.
15. Yuan SM. Fetal arrhythmias: Surveillance and management. Hellenic J Cardiol. 2019;60(2):72-81.
16. van den Heuvel F, Bink-Boelkens MT, du Marchie Sarvaas GJ, Berger RM. Drug management of fetal tachyarrhythmias: are we ready for a systematic and evidence-based approach? Pacing Clin Electrophysiol. 2008;31 Suppl 1:S54-7.
17. Hill GD, Kovach JR, Saudek DE, Singh AK, Wehrheim K, Frommelt MA. Transplacental treatment of fetal tachycardia: A systematic review and meta-analysis. Prenat Diagn. 2017;37(11):1076-83.
18. Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation. 2011;124(16):1747-54.
19. Jaeggi ET, Hamilton RM, Silverman ED, Zamora SA, Hornberger LK. Outcome of children with fetal, neonatal or childhood diagnosis of isolated congenital atrioventricular block. A single institution's experience of 30 years. J Am Coll Cardiol. 2002;39(1):130-7.
20. Frohn-Mulder IM, Stewart PA, Witsenburg M, Den Hollander NS, Wladimiroff JW, Hess J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diagn. 1995;15(13):1297-302.
21. Strasburger JF, Cuneo BF, Michon MM, Gotteiner NL, Deal BJ, McGregor SN, et al. Amiodarone therapy for drug-refractory fetal tachycardia. Circulation. 2004;109(3):375-9.
22. Sridharan S, Sullivan I, Tomek V, Wolfenden J, Škovránek J, Yates R, et al. Flecainide versus digoxin for fetal supraventricular tachycardia: Comparison of two drug treatment protocols. Heart Rhythm. 2016;13(9):1913-9.
23. van der Heijden LB, Oudijk MA, Manten GT, ter Heide H, Pistorius L, Freund MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2013;42(3):285-93.
24. Krapp M, Kohl T, Simpson JM, Sharland GK, Katalinic A, Gembruch U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart. 2003;89(8):913-7.
25. Uzun O, Sinha A, Beattie B. Letter by Uzun et al regarding article, "comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study". Circulation. 2012;125(20):e956.