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Association of Fetal Atrial Flutter with Neonatal Atrioventricular Re-entry Tachycardia Involving Accessory Pathway: A Link to be Remembered

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Abstract

To investigate prenatal and postnatal outcomes of atrial flutter and its association with the development of a second tachycardia, following restoration of sinus rhythm, in the fetus or newborn. This study is a retrospective review of all fetuses that presented with atrial flutter from January 2001 to December 2019 at the University Hospital of Wales, Cardiff, UK. The specific type of arrhythmia, its time of appearance and clinical characteristics, echocardiographic findings, medical management, and postnatal outcomes were evaluated. Sixteen fetuses were diagnosed with atrial flutter (AFL). Thirteen fetuses had persistent AFL and three fetuses had intermittent AFL. Seven patients had hydrops, of which one had Ebstein’s anomaly and the other six had normal hearts. Three of the fetuses that presented with AFL were diagnosed at 20, 21, and 23 weeks’ gestation and the remainder were diagnosed in the third trimester. Thirteen patients with AFL received antiarrhythmic drugs and three were delivered without any treatment. Five fetuses with AFL developed atrioventricular reciprocating tachycardia following DC cardioversion after birth, and four of them exhibited pre-excitation on the ECG. These five patients (31.3%) required postnatal antiarrhythmic treatment for up to 2 years. Pre-excitation disappeared in two patients during follow-up and two asymptomatic patients with neonatal pre-excitation required accessory pathway ablation. Fetal atrial flutter has a strong association with atrioventricular reciprocating tachycardia and ventricular pre-excitation in the neonatal period. Therefore, electrocardiograms should be carefully reviewed in newborns following the initial resolution of atrial flutter.

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Acknowledgements

We would like to thank all the midwives, nurses, ultrasonographers, radiologists, obstetricians, adult cardiologists, neonatologists, and pediatricians for their help and involvement in the management and follow-up of these patients.

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The authors received no financial support for the research and/or authorship of this article.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey

    Gulhan Tunca Sahin

  2. Sport Sciences and Cardiovascular Research, Faculty of Engineering and Sport Sciences, Swansea University, Swansea, UK

    Michael Lewis & Orhan Uzun

  3. University Hospital of Wales, Cardiff, UK

    Orhan Uzun

  4. School of Medicine, Cardiff University, Cardiff, UK

    Orhan Uzun

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  1. Gulhan Tunca Sahin
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  2. Michael Lewis
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  3. Orhan Uzun
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Contributions

OU had primary responsibility of the data collections, analysis of the results. GT and OU equally contributed to the paper in all stages by systematically organizing the data, critically appraising and writing of the manuscript. ML critically appraised and edited the paper.

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Correspondence to Gulhan Tunca Sahin.

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The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Ethical Approval

Since the data were collected as part of routine clinical work and completely anonymized prior to retrospective analysis, a specific ethical approval application was not considered necessary. All procedures relating to this review were carried out in accordance with the Declaration of Helsinki.

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Tunca Sahin, G., Lewis, M. & Uzun, O. Association of Fetal Atrial Flutter with Neonatal Atrioventricular Re-entry Tachycardia Involving Accessory Pathway: A Link to be Remembered. Pediatr Cardiol 42, 849–856 (2021). https://doi.org/10.1007/s00246-021-02549-6

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  • DOI: https://doi.org/10.1007/s00246-021-02549-6

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