Skip to main content
SpringerLink
Log in

Fetale Arrhythmien – ein Update

Fetal arrhythmias—An update

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Länger anhaltende Arrhythmien werden bei 1–2 % der Feten nachgewiesen. Differenziert werden fetale Arrhythmien mittels M‑mode- und Doppler-Echokardiographie. Überwachung und Therapie sind der vorliegenden Arrhythmie anzupassen. Bei Tachyarrhythmien werden transplazentar Digoxin, Flecainid, Sotalol und Amiodaron eingesetzt, wobei Flecainid bei atrioventrikulären Reentry-Tachykardien mehr und mehr primär eingesetzt wird. Beim inflammatorisch bedingten kompletten AV(atrioventrikulären)-Block (congenital complete heart block, CCHB) durch maternale Anti-SSA/Ro-Antikörper ist eine generelle transplazentare Behandlung mit hochdosierten fluorierten Kortikosteroiden zur Eindämmung einer begleitenden Myokarditis aufgrund des Nebenwirkungsprofils nicht indiziert; sie ist allenfalls bei Feten mit Zeichen kardialer Dysfunktion und kardialer Fibrose zu erwägen. Zur Prävention sollte im Hochrisikokollektiv (Wiederholungsrisiko bei vorherigem Kind mit CCHB 16–19 %) die tägliche Gabe von 400 mg Hydroxychloroquin (HCQ) bereits vor der 10. Schwangerschaftswoche (SSW) erfolgen, wodurch das Risiko halbiert werden kann. Derzeit nicht indiziert ist eine generelle HCQ bei allen Schwangeren mit nachweisbaren Anti-SSA/Ro-Antikörpern zwecks Prävention, da aufgrund des geringen Risikos von 1–2 % die „number needed to treat“ (NNT) 100+ beträgt und relevante kardiale Ereignisse aufgrund der HCQ-bedingten QT-Zeit-Verlängerung möglich erscheinen. Die lange Zeit empfohlene sehr aufwendige wöchentlich echokardiographische Messung der fetalen AV-Zeit mit dem Ziel, einen AV-Block I. Grades zu erkennen und durch Behandlung mit Dexamethason das Auftreten einer CCHB zu verhindern, hat sich mittlerweile als ineffektiv erweisen.

Abstract

Sustained fetal arrhythmias are detected in 1–2% of fetuses. Fetal arrhythmias are differentiated by M‑mode and Doppler echocardiography. Surveillance and treatment should be individually adapted to the arrhythmia. For tachyarrhythmias transplacental digoxin, flecainide, sotalol, and amiodarone are used, whereby flecainide is increasingly being used as first-line treatment for atrioventricular (AV) re-entry tachycardia. In cases of inflammation-related complete AV block (congenital complete hart block, CCHB) resulting from maternal anti-SSA/Ro antibodies, a general transplacental treatment with high-dose fluorinated corticosteroids to control concomitant myocarditis is not indicated because of the side effect profile; at most it should be considered for fetuses with signs of cardiac dysfunction and cardiac fibrosis. For prevention, daily administration of 400 mg hydroxychloroquine (HCQ) should already be given before the 10th week of gestation in the high-risk cohort (recurrence rate in previous child with CCHB 16–19%), which can halve the risk. Currently, a general HCQ is not indicated in all pregnant women with detectable anti-SSA/Ro antibodies for the purpose of prevention, as the number needed to treat (NNT) is 100+ due to the low risk of 1–2% for occurrence of CCHB and relevant cardiac events appear possible due to HCQ-related QT time prolongation. The very labor-intensive weekly echocardiographic measurement of the fetal AV interval, which was recommended for a long time, with the aim of detecting a first degree AV block and preventing the occurrence of CCHB by treatment with dexamethasone, has meanwhile proved to be ineffective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Alsaied T, Baskar S, Fares M et al (2017) First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta-analysis. J Am Heart Assoc 6:e7164

    Article  PubMed  PubMed Central  Google Scholar 

  2. Andersson NW, Skov L, Andersen JT (2020) Fetal safety of chloroquine and hydroxychloroquine use during pregnancy: a nationwide cohort study. Rheumatology 60:2317–2326

    Article  Google Scholar 

  3. Bar-Cohen Y, Loeb GE, Pruetz JD et al (2015) Preclinical testing and optimization of a novel fetal micropacemaker. Heart Rhythm 12:1683–1690

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bartin R, Maltret A, Nicloux M et al (2021) Outcomes of sustained fetal tachyarrhythmias after transplacental treatment. Heart Rhythm 2:160–167

    Article  Google Scholar 

  5. Baschat AA, Gembruch U, Knöpfle G, Hansmann M (1999) First-trimester fetal heart block: a marker for cardiac anomaly. Ultrasound Obstet Gynecol 14:311–314

    Article  CAS  PubMed  Google Scholar 

  6. Bérard A, Sheehy O, Zhao JP et al (2021) Chloroquine and hydroxychloroquine use during pregnancy and the risk of adverse pregnancy outcomes using real-world evidence. Front Pharmacol 12:722511

    Article  PubMed  PubMed Central  Google Scholar 

  7. Berg C, Geipel A, Smrcek J et al (2003) Prenatal diagnosis of cardiosplenic syndromes: a 10-year experience. Ultrasound Obstet Gynecol 22:451–459

    Article  CAS  PubMed  Google Scholar 

  8. Berg C, Geipel A, Kohl T et al (2005) Atrioventricular block detected in fetal life: associated anomalies and potential prognostic markers. Ultrasound Obstet Gynecol 26:4–15

    Article  CAS  PubMed  Google Scholar 

  9. Berg C, Geipel A, Kamil D et al (2005) The syndrome of left isomerism: sonographic findings and outcomes in prenatally diagnosed cases. J Ultrasound Med 24:921–931

    Article  PubMed  Google Scholar 

  10. Berg C, Gottschalk I, Geipel A, Gembruch U (2013) Diagnosis and therapy of fetal arrhythmias 1—methods of rhythm diagnosis, extrasystole and bradyarrhythias. Ultraschall Med 34:114–127

    Article  CAS  PubMed  Google Scholar 

  11. Berg C, Gottschalk I, Gembruch U, Geipel A (2013) Diagnosis and therapy of fetal arrhythmia part 2—Fetal tachyarrhythmias and their intrauterine treatment. Ultraschall Med 34:322–331

    Article  CAS  PubMed  Google Scholar 

  12. Bergman G, Eliasson H, Mohlkert LA et al (2012) Progression to first-degree heart block in preschool children exposed in utero to maternal anti-SSA/Ro52 autoantibodies. Acta Paediatr 101:488–493

    Article  CAS  PubMed  Google Scholar 

  13. Ciobanu AM, Dumitru AE, Gica N et al (2020) Benefits and risks of IgG transplacental transfer. Diagnostics 10:583

    Article  CAS  PubMed Central  Google Scholar 

  14. Ciardulli A, D’Antonio F, Magro-Malosso ER et al (2018) Maternal steroid therapy for fetuses with second-degree immune-mediated congenital atrioventricular block: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 97:787–794

    Article  CAS  PubMed  Google Scholar 

  15. Clur SB, Vink AS, Etheridge SP et al (2018) Left ventricular isovolumetric relaxation time is prolonged in fetal long-QT syndrome. Circ Arrhythm Electrophysiol 11:e5797

    Article  PubMed  Google Scholar 

  16. Cuneo BF (2019) Fetal bradycardia. In: Yagel S, Silverman NH, Gembruch U (Hrsg) Fetal cardiology: embryology, genetics, physiology, echocardiographic evaluation, diagnosis, and perinatal management of cardiac diseases. CRC Press, Taylor & Francis Group, Boca Raton, S 513–529

    Google Scholar 

  17. Cuneo BF, Bitant S, Strasburger JF et al (2019) Assessment of atrioventricular conduction by echocardiography and magnetocardiography in normal and anti-Ro/SSA-antibody-positive pregnancies. Ultrasound Obstet Gynecol 54:625–633

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Cuneo BF, Buyon JP (2019) Keeping upbeat to prevent the heartbreak of anti-Ro/SSA pregnancy. Ultrasound Obstet Gynecol 54:7–9

    Article  CAS  PubMed  Google Scholar 

  19. Cuneo BF, Etheridge SP, Horigome H et al (2013) Arrhythmia phenotype during fetal life suggests long-QT syndrome genotype: risk stratification of perinatal long-QT syndrome. Circ Arrhythm Electrophysiol 6:946–951

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cuneo BF, Sonesson SE, Levasseur S et al (2018) Home monitoring for fetal heart rhythm during anti-Ro pregnancies. J Am Coll Cardiol 72:1940–1951

    Article  PubMed  Google Scholar 

  21. Cuneo BF, Strasburger JF, Yu S et al (2013) In utero diagnosis of long QT syndrome by magnetocardiography. Circulation 128:2183–2191

    Article  PubMed  Google Scholar 

  22. Eliasson H, Sonesson SE, Sharland G et al (2011) Isolated atrioventricular block in the fetus: a retrospective, multinational, multicenter study of 175 patients. Circulation 124:1919–1926

    Article  PubMed  Google Scholar 

  23. Fredi M, Andreoli L, Bacco B et al (2019) First report of the Italian registry on immune-mediated congenital heart block (Lu.Ne Registry). Front Cardiovasc Med 6:11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Friedman DM, Kim MY, Copel JA et al (2009) Prospective evaluation of fetuses with autoimmune-associated congenital heart block followed in the PR Interval and Dexamethasone Evaluation (PRIDE) Study. Am J Cardiol 103:1102–1106

    Article  PubMed  PubMed Central  Google Scholar 

  25. Friedman DM, Kim M, Costedoat-Chalumeau N et al (2020) Electrocardiographic QT intervals in infants exposed to hydroxychloroquine throughout gestation. Circ Arrhythm Electrophysiol 13:e8686

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Friedman DM, Llanos C, Izmirly PM et al (2010) Evaluation of fetuses in a study of intravenous immunoglobulin as preventive therapy for congenital heart block: Results of a multicenter, prospective, open-label clinical trial. Arthritis Rheum 62:1138–1146

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Gembruch U (2019) Fetal tachyarrhythmia. In: Yagel S, Silverman N, Gembruch U (Hrsg) Fetal cardiology, 3. Aufl. CRC Press, Taylor & Francis, Boca Raton, S 530–547

    Google Scholar 

  28. Gembruch U, Bald R, Hansmann M (1990) Die farbkodierte M‑mode-Doppler-Echokardiographie bei der Diagnostik fetaler Arrhythmien. Geburtshilfe Frauenheilkd 50:286–290

    Article  CAS  PubMed  Google Scholar 

  29. Gembruch U, Hansmann M, Redel DA, Bald (1988) Intrauterine therapy of fetal tachyarrhythmias: intraperitoneal administration of antiarrhythmic drugs to the fetus in fetal tachyarrhythmias with severe hydrops fetalis. J Perinat Med 16:39–44

    Article  CAS  PubMed  Google Scholar 

  30. Gembruch U, Hansmann M, Redel DA et al (1989) Fetal complete heart block: antenatal diagnosis, significance and management. Eur J Obstet Gynecol Reprod Biol 31:9–22

    Article  CAS  PubMed  Google Scholar 

  31. Gembruch U, Krapp M, Baumann P (1995) Changes of venous blood flow velocity waveforms in fetuses with supraventricular tachycardia. Ultrasound Obstet Gynecol 5:394–399

    Article  CAS  PubMed  Google Scholar 

  32. Gembruch U, Krapp M, Germer U, Baumann P (1999) Venous Doppler in the sonographic surveillance of fetuses with supraventricular tachycardia. Eur J Obstet Gynecol Reprod Biol 84:187–192

    Article  CAS  PubMed  Google Scholar 

  33. Gembruch U, Manz M, Bald R et al (1989) Repeated intravascular treatment with amiodarone in a fetus with refractory supraventricular tachycardia and hydrops fetalis. Am Heart J 118:1335–1338

    Article  CAS  PubMed  Google Scholar 

  34. Gembruch U, Redel DA, Bald R, Hansmann M (1993) Longitudinal study in 18 cases of fetal supraventricular tachycardia: Doppler-echocardiographic findings and pathophysiological implications. Am Heart J 125:1290–1301

    Article  CAS  PubMed  Google Scholar 

  35. Gest AL, Bair DK, Vander Straten MC (1993) Thoracic duct lymph flow in fetal sheep with increased venous pressure from electrically induced tachycardia. Biol Neonate 64:325–330

    Article  CAS  PubMed  Google Scholar 

  36. Gest AL, Martin CG, Moise AA, Hansen TN (1990) Reversal of venous blood flow with atrial tachycardia and hydrops in fetal sheep. Pediatr Res 28:223–226

    Article  CAS  PubMed  Google Scholar 

  37. Groves AMM, Allan LD, Rosenthal E (1995) Therapeutic trial of sympathomimetics in three cases of complete heart block in the fetus. Circulation 92:3394–3396

    Article  CAS  PubMed  Google Scholar 

  38. Guettrot-Imbert G, Cohen L, Fermont L et al (2011) A new presentation of neonatal lupus: 5 cases of isolated mild endocardial fibroelastosis associated with maternal anti-Ro/SSA and anti-La/SSB antibodies. J Rheumatol 38:378–386

    Article  PubMed  Google Scholar 

  39. Hansmann M, Gembruch U, Bald R et al (1991) Fetal tachyarrhythmias: transplacental and direct treatment of the fetus—a report of sixty fetuses. Ultrasound Obstet Gynecol 1:162–170

    Article  CAS  PubMed  Google Scholar 

  40. van der Heijden LB, Oudijk MA, Manten GT et al (2013) Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstet Gynecol 42:285–293

    Article  PubMed  Google Scholar 

  41. Hill GD, Kovach JR, Saudek DE et al (2017) Transplacental treatment of fetal tachycardia: a systematic review and meta-analysis. Prenat Diagn 37:1076–1083

    Article  CAS  PubMed  Google Scholar 

  42. Ho SY, Esscher E, Anderson RH, Michaelsson M (1986) Anatomy of congenital complete heart block and relation to maternal anti-Ro-antibodies. Am J Cardiol 58:291–294

    Article  CAS  PubMed  Google Scholar 

  43. Ho SY, Fagg N, Anderson RH et al (1992) Disposition of the atrioventricular conduction tissues in the heart with isomerism of the atrial appendages: its relation to congenital complete heart block. J Am Coll Cardiol 20:904–910

    Article  CAS  PubMed  Google Scholar 

  44. Hutter D, Silverman ED, Jaeggi ET (2010) The benefits of transplacental treatment of isolated congenital complete heart block associated with maternal anti-Ro/SSA antibodies: a review. Scand J Immunol 72:235–241

    Article  CAS  PubMed  Google Scholar 

  45. Huybrechts KF, Bateman BT, Zhu Y et al (2021) Hydroxychloroquine early in pregnancy and risk of birth defects. Am J Obstet Gynecol 224:290.e1–290.e22

    Article  CAS  Google Scholar 

  46. Izmirly PM, Costedoat-Chalumeau N, Pisoni CN et al (2012) Maternal use of hydroxychloroquine is associated with a reduced risk of recurrent anti-SSA/Ro-antibody-associated cardiac manifestations of neonatal lupus. Circulation 126:76–82

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Izmirly P, Kim M, Friedman DM et al (2020) Hydroxychloroquine to prevent recurrent congenital heart block in fetuses of anti-SSA/Ro-positive mothers. J Am Coll Cardiol 76:292–302

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Izmirly PM, Saxena A, Sahl SK et al (2016) Assessment of fluorinated steroids to avert progression and mortality in anti-SSA/Ro-associated cardiac injury limited to the fetal conduction system. Ann Rheum Dis 75:1161–1165

    Article  CAS  PubMed  Google Scholar 

  49. Jaeggi ET (2019) Electrophysiology for the perinataologist. In: Yagel S, Silverman NH, Gembruch U (Hrsg) Fetal cardiology: embryology, genetics, physiology, echocardiographic evaluation, diagnosis, and perinatal management of cardiac diseases. CRC Press, Taylor & Francis Group, Boca Raton, S 504–514

    Google Scholar 

  50. Jaeggi ET, Carvalho JS, De Groot E et al (2011) Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 124:1747–1754

    Article  CAS  PubMed  Google Scholar 

  51. Jaeggi ET, Fouron JC, Silverman ED et al (2004) Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation 110:1542–1548

    Article  PubMed  Google Scholar 

  52. Jaeggi ET, Hornberger LK, Smallhorn JF, Fouron JC (2005) Prenatal diagnosis of complete atrioventricular block associated with structural heart disease: combined experience of two tertiary care centers and review of the literature. Ultrasound Obstet Gynecol 26:16–21

    Article  CAS  PubMed  Google Scholar 

  53. Jaeggi E, Laskin C, Hamilton R et al (2010) The importance of the level of maternal anti-Ro/SSA antibodies as a prognostic marker of the development of cardiac neonatal lupus erythematosus: a prospective study of 186 antibody-exposed fetuses and infants. J Am Coll Cardiol 55:2778–2784

    Article  CAS  PubMed  Google Scholar 

  54. Jaeggi ET, Silverman ED, Laskin C et al (2011) Prolongation of the atrioventricular conduction in fetuses exposed to maternal anti-Ro/SSA and anti-La/SSB antibodies did not predict progressive heart block. A prospective observational study on the effects of maternal antibodies on 165 fetuses. J Am Coll Cardiol 57:1487–1492

    Article  PubMed  Google Scholar 

  55. Jobe AH, Goldenberg RL (2018) Antenatal corticosteroids: an assessment of anticipated benefits and potential risks. Am J Obstet Gynecol 219:62–74

    Article  CAS  PubMed  Google Scholar 

  56. Jouannic JM, Delahaye S, Fermont L et al (2003) Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy. Prenat Diagn 23:152–156

    Article  PubMed  Google Scholar 

  57. Kan N, Silverman ED, Kingdom J et al (2017) Serial echocardiography for immune-mediated heart disease in the fetus: results of a risk-based prospective surveillance strategy. Prenat Diagn 37:375–382

    Article  CAS  PubMed  Google Scholar 

  58. Ko JK, Deal BJ, Strasburger JF et al (1992) Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 69:1028–1031

    Article  CAS  PubMed  Google Scholar 

  59. Kothari DS, Skinner JR (2006) Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed 91:136–144

    Article  Google Scholar 

  60. Krapp M, Baschat AA, Gembruch U et al (2002) Flecainide in the intrauterine treatment of fetal suparventricular tachycardia. Ultrasound Obstet Gynecol 19:158–164

    Article  CAS  PubMed  Google Scholar 

  61. Krapp M, Gembruch U, Baumann P (1997) Venous blood flow pattern suggesting tachycardia-induced cardiomyopathy in the fetus. Ultrasound Obstet Gynecol 10:32–40

    Article  CAS  PubMed  Google Scholar 

  62. Krapp M, Kohl T, Simpson JM et al (2003) Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart 89:913–917

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Krummholz A, Gottschalk I, Geipel A et al (2021) Prenatal diagnosis, associated findings and postnatal outcome in fetuses with congenitally corrected transposition of the great arteries. Arch Gynecol Obstet 303:1469–1481

    Article  PubMed  Google Scholar 

  64. Lazzerini PE, Laghi-Pasini F, Boutjdir M, Capecchi PL (2021) Anti-Ro/SSA antibodies and the autoimmune long-QT syndrome. Front Med 8:730161

    Article  Google Scholar 

  65. Lin PH, Wu HH, Tsai HD, Hsieh CT (2016) Successful treatment of atrial flutter by repeated intraperitoneal and intra-amniotic injections of amiodarone in a fetus with hydrops. Taiwan J Obstet Gynecol 55:434–436

    Article  PubMed  Google Scholar 

  66. Limaye MA, Buyon JP, Cuneo BF, Mehta-Lee SS (2020) A review of fetal and neonatal consequences of maternal systemic lupus erythematosus. Prenat Diagn 40:1066–1076

    Article  CAS  PubMed  Google Scholar 

  67. Michaelsson M, Engle MA (1972) Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 4:85–101

    CAS  PubMed  Google Scholar 

  68. Mitchell JL, Cuneo BF, Etheridge SP et al (2012) Fetal heart rate predictors of long QT syndrome. Circulation 126:2688–2695

    Article  PubMed  Google Scholar 

  69. Miyoshi T, Maeno Y, Hamasaki T et al (2019) Antenatal therapy for fetal supraventricular tachyarrhythmias: multicenter trial. J Am Coll Cardiol 74:874–885

    Article  CAS  PubMed  Google Scholar 

  70. Mofors J, Eliasson H, Ambrosi A et al (2019) Comorbidity and long-term outcome in patients with congenital heart block and their siblings exposed to Ro/SSA autoantibodies in utero. Ann Rheum Dis 78:696–703

    Article  PubMed  Google Scholar 

  71. Naheed ZJ, Strasburger JF, Deal BJ et al (1996) Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol 27:1736–1740

    Article  CAS  PubMed  Google Scholar 

  72. Narang K, Rose CH, Johnson JN et al (2020) Rare case of fetal permanent junctional reciprocating tachycardia refractory to prenatal antiarrhythmic therapy. Mayo Clin Proc Innov Qual Outcomes 4:810–814

    Article  PubMed  PubMed Central  Google Scholar 

  73. Phoon CKL, Kim MY, Buyon JP, Friedman DM (2012) Finding the “PR-fect” solution: what is the best tool to measure fetal cardiac PR intervals for the detection and possible treatment of early conduction disease? Congenit Heart Dis 7:349–360

    Article  PubMed  PubMed Central  Google Scholar 

  74. Pisoni CN, Brucato A, Ruffatti A et al (2010) Failure of intravenous immunoglobulin to prevent congenital heart block: findings of a multicenter, prospective, observational study. Arthritis Rheum 62:1147–1152

    Article  CAS  PubMed  Google Scholar 

  75. Pruetz JD, Miller JC, Loeb GE et al (2019) Prenatal diagnosis and management of congenital complete heart block. Birth Defects Res 111:380–388

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Rein AJJT, O’Donnell C, Geva T et al (2002) Use of tissue velocity imaging in the diagnosis of fetal cardiac arrhythmias. Circulation 106:1827–1833

    Article  CAS  PubMed  Google Scholar 

  77. Saito M, Silverman E, Golding F et al (2021) Effects of transplacental dexamethasone therapy on fetal immune-mediated complete heart block. Fetal Diagn Ther 48:183–188

    Article  PubMed  Google Scholar 

  78. Sethi N, Funamoto K, Ingbar C et al (2020) Noninvasive fetal electrocardiography in the diagnosis of long QT syndrome: a case series. Fetal Diagn Ther 47:711–716

    Article  PubMed  Google Scholar 

  79. Shokrzadeh A, Maltret A, Morel N et al (2021) Longitudinal analysis of fetal ventricular rate for risk stratification in immune congenital heart block. Fetal Diagn Ther 48:1–8

    Article  PubMed  Google Scholar 

  80. Spinale FG, Tanaka R, Crawford FA, Zile MR (1992) Changes in myocardial blood flow during development of and recovery from tachycardia-induced cardiomyopathy. Circulation 85:717–729

    Article  CAS  Google Scholar 

  81. Sonesson SE, Ambrosi A, Wahren-Herlenius M (2019) Benefits of fetal echocardiographic surveillance in pregnancies at risk of congenital heart block: Single-center study of 212 anti-Ro52-positive pregnancies. Ultrasound Obstet Gynecol 54:87–95

    Article  PubMed  Google Scholar 

  82. Sonesson SE, Salomonsson S, Jacobsson LA et al (2004) Signs of first-degree heart block occur in one-third of fetuses of pregnant women with anti-SSA/Ro 52-kd antibodies. Arthritis Rheum 50:1253–1261

    Article  CAS  PubMed  Google Scholar 

  83. Sridharan S, Sullivan I, Tomek V et al (2016) Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols. Heart Rhythm 13:1913–1919

    Article  PubMed  Google Scholar 

  84. Stevens DC, Hilliard JK, Schreiner RL et al (1982) Supraventricular tachycardia with edema, ascites, and hydrops in fetal sheep. Am J Obstet Gynecol 142:316–322

    Article  CAS  PubMed  Google Scholar 

  85. Stirnemann J, Maltret A, Haydar A et al (2018) Successful in utero transesophageal pacing for severe drug-resistant tachyarrhythmia. Am J Obstet Gynecol 219:320–325

    Article  PubMed  Google Scholar 

  86. Strand S, Strasburger JF, Cuneo BF, Wakai RT (2020) Complex and novel arrhythmias precede stillbirth in fetuses with de novo long QT syndrome. Circ Arrhythm Electrophysiol 13:e8082

    Article  PubMed  PubMed Central  Google Scholar 

  87. Strand SA, Strasburger JF, Wakai RT (2019) Fetal magnetocardiogram waveform characteristics. Physiol Meas 40:35002

    Article  PubMed  PubMed Central  Google Scholar 

  88. Strasburger JF, Cuneo BF, Michon MM et al (2004) Amiodarone therapy for drug-refractory fetal tachycardia. Circulation 109:375–379

    Article  CAS  PubMed  Google Scholar 

  89. Strasburger JF, Wacker-Gussmann A (2020) Congenital heart block in subsequent pregnancies of SSA/Ro-positive mothers: cutting recurrence in half. J Am Coll Cardiol 76:303–305

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Strizek B, Berg C, Gottschalk I et al (2016) High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm 13:1283–1288

    Article  PubMed  Google Scholar 

  91. Trucco SM, Jaeggi E, Cuneo B et al (2011) Use of intravenous gamma globulin and corticosteroids in the treatment of maternal autoantibody-mediated cardiomyopathy. J Am Coll Cardiol 57:715–723

    Article  PubMed  Google Scholar 

  92. Veduta A, Panaitescu AM, Ciobanu AM et al (2021) Treatment of fetal arrhythmias. J Clin Med 10:2510

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Wakai RT, Strasburger JF, Li Z et al (2003) Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia. Circulation 107:307–312

    Article  CAS  PubMed  Google Scholar 

  94. Wacker-Gussmann A, Strasburger JF, Cuneo BF, Wakai RT (2014) Diagnosis and treatment of fetal arrhythmia. Am J Perinatol 31:617–628

    Article  PubMed  PubMed Central  Google Scholar 

  95. Willruth A, Steinhard J, Enzensberger C et al (2016) Fetal colour tissue Doppler imaging (cTDI): biventricular reference ranges for the time segments of the cardiac cycle in second and third trimesters of gestation. Arch Gynecol Obstet 294:917–924

    Article  PubMed  Google Scholar 

  96. Yuan SM, Xu ZY (2020) Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics. Ital J Pediatr 46:21

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland

    Ulrich Gembruch

Authors
  1. Ulrich Gembruch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulrich Gembruch.

Ethics declarations

Interessenkonflikt

U. Gembruch gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

Jan Weichert, Lübeck

Ulrich Gembruch, Bonn

Klaus Diedrich, Lübeck

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gembruch, U. Fetale Arrhythmien – ein Update. Gynäkologe 55, 39–50 (2022). https://doi.org/10.1007/s00129-021-04887-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-021-04887-1

Schlüsselwörter

Keywords

Search

Navigation