Persistent junctional reciprocating tachycardia in the fetus.

Details

Serval ID
serval:BIB_29714
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Persistent junctional reciprocating tachycardia in the fetus.
Journal
The Journal of Maternal-Fetal and Neonatal Medicine
Author(s)
Oudijk M.A., Stoutenbeek P., Sreeram N., Visser G.H., Meijboom E.J.
ISSN
1476-7058
Publication state
Published
Issued date
2003
Volume
13
Number
3
Pages
191-196
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
BACKGROUND: Persistent junctional reciprocating tachycardia (PJRT) tends to be a persistent arrhythmia and requires aggressive therapeutic management. Diagnosis and management of this infrequently occurring tachycardia in the fetus at an early stage is of importance for the prevention of congestive heart failure (CHF). METHODS: A retrospective study of four fetuses with supraventricular tachycardia (SVT) of the PJRT type was performed. RESULTS: All had sustained SVT (mean of 228 beats/min) at a mean gestational age of 34 + 5 weeks, with CHF present in two. Three fetuses had prenatal characteristics of PJRT on M-mode echocardiography with a ventriculoatrial (VA)/atrioventricular ratio of > 1 on M-mode echocardiography suggesting a slow conducting accessory pathway. All four fetuses had postnatal confirmation of the diagnosis. Transplacental treatment with flecainide was effective in one patient; sotalol as a single drug or in combination with digoxin was partially effective in the remaining three. Two developed sinus rhythm, with short intermittent periods of tachycardia and decreasing signs of CHF; one case showed a minimal decrease in heart rate. Oral propranolol therapy converted two patients postnatally; in the remaining two patients radiofrequency ablation was performed at the age of 5 months and 6 years. CONCLUSIONS: The characteristics of our prenatal PJRT cases included a sustained heart rate not exceeding 240 beats/min with a long VA interval, the presence of CHF and therapy resistance. Transplacental treatment should be initiated, possibly with a combination of sotalol and digoxin in non-hydropic cases, or flecainide, especially in case of fetal hydrops. Pharmacological therapy is to be preferred postnatally, but radiofrequency ablation seems to be indicated in therapy-resistant cases with CHF, even in the first months of life.
Keywords
Adult, Diagnosis, Differential, Echocardiography, Female, Fetal Distress/diagnosis, Fetal Distress/therapy, Humans, Pregnancy, Pregnancy Trimester, Third, Retrospective Studies, Tachycardia, Supraventricular/diagnosis, Tachycardia, Supraventricular/therapy, Ultrasonography, Prenatal
Pubmed
Create date
19/11/2007 12:27
Last modification date
20/08/2019 13:09
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