Original research

Ultrasound diagnosis and monitoring of fetal tachyarrhythmias

Yu.А. Ivaniv, N.V. Lozynska

Danylo Galyckyi Lviv National Medical University, Ukraine

The aim – to evaluate the efficiency of prenatal echocardiography in detecting, differential diagnosis and monitoring fetuses with tachyarrhythmias.

Materials and methods. Investigations performed in a single center from April 1996 to July 2016 were analysed. During this study 2,073 pregnant women were examined and 213 cases of fetal arrhythmia were found (10.3 %). Prenatal echocardiography was conducted by general protocol, each examination were fixed and saved in electronic and paper form.

Results. During this period 25 cases of fetal tachyarrhythmias were diagnosed, representing 11.7 % of all cases of arrhythmia and 1.2 % of all fetal heart examinations. In five fetuses tachyarrhythmia was combined with structural heart disorders, which constitutes 20 % among all tachyarrhythmias. Most fetal tachyarrhythmias (21) were diagnosed during third trimester of pregnancy. The most common fetal tachyarrhythmia was atrioventricular «re-entry» tachycardia – 14 cases (56 %). None case of this group was combined with structural cardiac pathology, however, almost half were accompanied by hemodynamic complications. Drug treatment was effective in this group. Atrial fibrillation was second prevalent in our study, 4 cases (16 %) – dangerous arrhythmia, which in most fetuses caused circulatory failure, being combined with congenital heart defect or myocardial pathology. Drug treatment in this group is less effective, depending on comorbidity and age pregnancy. We diagnosed 4 cases of sinus tachycardia (16 %), largely having benign course in the prenatal period and not requiring drug treatment. Prognosis of pregnancy is determined by concomitant diseases of the fetus. One case (4 %) of atrial flutter required preterm delivery through the hemodynamic complications. Ectopic atrial tachycardia was diagnosed in two fetuses (8 %). This arrhythmia is insensitive to medical treatment and may persist after birth.

Conclusions. Clinical management of pregnancy, the need for treatment and choice of effective antiarrhythmic drugs depends on the type of tachyarrhythmias. Prenatal echocardiography provides reliable monitoring of the fetus condition and effectiveness of antiarrhythmic treatment, determining the tactics during pregnancy, helps to plan childbirth and defines treatment after birth.

Key words: prenatal echocardiography, fetal heart, fetal tachyarrhythmia.