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CC BY-NC-ND 4.0 · Journal of Fetal Medicine 2020; 07(03): 205-211
DOI: 10.1007/s40556-020-00264-5
Original Article

Importance of Analysis of Arrhythmia Mechanism in Predicting Outcomes in Fetal Bradycardia: A Single-Centre Retrospective Study from a Dedicated Fetal Cardiology Unit in South India

Jasmine Lall
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
,
Roshan Valsan
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
,
Anu Paul
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
,
Stephy Thomas
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
,
Abish Sudhakar
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
,
Balu Vaidyanathan 
1   The Fetal Cardiology Division, Department of Paediatric Cardiology, Amrita Institute of Medical Sciences, 682 041, Kochi, Kerala, India
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Abstract

Few studies have correlated the mechanism of fetal bradycardia to pregnancy outcomes. This study aimed to correlate the arrhythmia mechanism to pregnancy and early postnatal outcomes in fetal bradycardia. This was retrospective study (May 2013–November 2019). Fetuses with sustained bradycardia (heart rate ≤ 100 per minute) were included. Based on arrhythmia mechanism, patients were categorized into 4 groups:Group 1: blocked atrial ectopics, Group 2: second-degree atrioventricular block (AVB), Group 3: complete AVB and group 4: sinus bradycardia. Clinical presentation, need for transplacental therapy, pregnancy and early postnatal outcomes were analysed. A total of 36 patients were included. Mean gestational age was 26.2 ± 5.5 weeks. The most common arrhythmia mechanism was Group 3 (N = 24; 66.7%) followed by Group 2 (N = 5; 13.8%); groups 1 and 4 had 4 and 3 patients respectively. Maternal auto-antibodies were reported in 21 patients (58.3%); 19 were in Group 3. Transplacental therapy was needed in 15 (41.7%) cases; 14 were in Group 3. Live-birth was reported in 23 cases (63.9%), other outcomes included pregnancy termination (n = 7), intra-uterine death (n = 4) and lost to follow-up (n = 2). Live-births were most common in Groups 1 (100%) and 2 (80%), followed by Group 3 (54.2%). Postnatal mortality occurred in one patient (Group 2). Three patients (60%) in Group 2 had Long QT syndrome in postnatal evaluation. Eight patients (6 in group 3) needed pacemaker implantation after birth. Fetal bradycardia was associated with an overall favorable pregnancy and good early postnatal outcomes. Analysis of the arrhythmia mechanism should guide prognostication and decisions for transplacental therapy.

Keywords

Fetal bradycardia - Arrhythmia mechanism - Perinatal outcomes


Publication History

Received: 15 May 2020

Accepted: 10 August 2020

Article published online:
05 May 2023

© 2020. Society of Fetal Medicine. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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