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Prenatal Diagnosis, Management, and Clinical Outcomes of Fetal Arrhythmias: A 4-Year Experience from a Single Tertiary Center
Verda Alpay1, Fırat Ersan1, Baris Boza1, İsa Özyılmaz21Department of Obstetrics and Gynecology, Division of Perinatology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey2Department of Pediatrics, Division of Pediatric Cardiology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
INTRODUCTION: Fetal arrhythmias complicate 1-2% of all pregnancies and can be categorized into three types: rhythm irregularities. tachyarrhythmias and bradyarrhythmias. The rate, duration and severity of the arrhythmia typically determine its hemodynamic consequences. The aim of this study was to evaluate prenatal management strategies and clinical outcomes of fetal arrhythmias in a tertiary perinatal center over a 4 year period.
METHODS: We retrospectively reviewed 46 fetuses diagnosed with arrhythmia between October 2020 and December 2024. Maternal characteristics, type and of arrhythmia, prenatal treatment, birth parameters and neonatal outcomes were collected.
RESULTS: Forty-six cases of fetal arrhythmia were included in the study. The participants were divided into three groups based on arrhythmia type: rhythm irregularities (n=21, 46%), bradyarrhythmias (n=14, 30%), and tachyarrhythmias (n=11, 24%). Most patients in the bradyarrhythmia group (n=7, %50) were diagnosed with complete atrioventricular block (CAVB), all of whom tested positive for maternal autoantibodies. Supraventricular tachycardia was the most common type of tachyarrhythmia observed, followed by 2: 1 atrial flutter.
DISCUSSION AND CONCLUSION: Fetuses with rhythm irregularities generally have favorable outcomes. The course of fetal CAVB associated with congenital heart defects, particularly left atrial isomerism, appear to be worse than that of immune-mediated CAVB. Persistent tachyarrhythmias should be treated in utero due to the risk of rapid progression to cardiac failure. Once fetal arrhythmias are diagnosed, close follow-up and parental counseling is recommended, using a multidisciplinary team approach involving pediatric cardiology and maternal-fetal medicine specialists.
Keywords: fetal arrhythmia, fetal tachyarrhythmia, fetal bradyarrhythmia, echocardiography, antiarrhythmic therapy, hydrops fetalis, prenatal diagnosis
Manuscript Language: English