Background: Fetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Despite a transplacental treatment, failure to obtain or maintain sinus rhythm may occur.
Objective: We aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment.
Methods: We performed a retrospective evaluation of 69 cases with sustained fetal tachyarrhythmia. We compared the perinatal and long-term outcomes of prenatally converted and drug-resistant fetuses. Tachyarrhythmia subtypes were also evaluated.
Results: Conversion to sinus rhythm was obtained in 74% of cases; 26% of cases were drug-resistant and delivered arrhythmic. Three perinatal deaths occurred in both groups (6.7% vs 17%, = .34). Neonates delivered arrhythmic were more frequently admitted to neonatal intensive care units (75% vs 31%, < .01), and their hospital stay was longer (20.9 vs 6.64 days, < .001). Multiple neonatal recurrences (81% vs 11%, < .001), temporary hemodynamic dysfunction or heart failure (50% vs 6.7%, < .001), and postnatal use of a combination treatment (44% vs 13%, = .028) were also more frequent in this population. Beyond the neonatal period, rates of recurrences within the first 16 months were higher in drug-resistant fetuses (HR = 16.14, CI 95% [4.485; 193.8], < .001). In this population, postnatal electrocardiogram revealed an overrepresentation of rare mechanisms, especially permanent junctional reciprocating tachycardia (PJRT) (31%).
Conclusion: Prenatal conversion to stable sinus rhythm is a major determinant of perinatal and long-term outcomes in fetal tachyarrhythmias. The underlying electrophysiological mechanisms have a major role in predicting these differential outcomes with an overrepresentation of PJRT in the drug-resistant population.
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| http://dx.doi.org/10.1016/j.hroo.2021.02.006 | DOI Listing |
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