1. Fetal Ventricular Rhythm disturbances: 20-years institutional experience
Wadi Mawad, M.D., Sylvia Abadir, M.D., Anne Fournier,M.D., Myriam Brassard, M.D., Jean Claude Fouron, M.D., Marie Josée Raboisson, M.D.
Division of Paediatric Cardiology, Department of Paediatrics, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
Introduction
In fetuses, ventricular arrhythmia is rare. Prenatal diagnosis is challenging and relatively little is known on the management and prognosis of such arrhythmia. We sought to report our institution's experience on fetal ventricular arrhythmia over the last 20 years with a special focus on superior vena cava-aorta Doppler as diagnosis tool.
Methods
Maternal and fetal charts and fetal cardiac echoes with a ventricular rhythm disturbance of any kind were reviewed between in our database.
Results
23 patients had ventricular arrhythmia in 20 years. 6 patients had sustained ventricular tachycardia, one of which had torsades de pointe related to long Qt syndrome, 3 with ventricular tachycardia and 2 with junctionnal ectopic tachycardia (JET). 1 subject with VT and another with JET had hydrops and were treated with amiodarone and a combination of sotalol and digoxin respectively. Seventeen patients had isolated PVCs. None had signs of hydrops with normal anatomies except for 2 cases. All these patients had normal sinus rhythm after birth. None of the patients progressed to ventricular tachycardia during gestation.
Conclusion
Our experience over the last 20 years supports the available literature with regards to fetal ventricular rhythm disturbances, showing very few cases of VT with favorable postnatal courses. The mechanisms underlying fetal VT remain unknown but could be related to delayed maturation of repolarization or exaggerated normal electrophysiological inhomogeneity within the developing myocardium related to ion channel and connexin expression.