Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia.
OBJECTIVE
To review the diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia.


METHODS
Retrospective review of published reports: 11 papers about fetal tachyarrhythmia published between 1991 and 2002 were selected for review.


METHODS
All selected studies were analysed for the type of arrhythmia, degree of atrioventricular block in atrial flutter, occurrence of hydrops fetalis, gestational age at diagnosis, first and second line drug treatment, associated cardiac and extracardiac malformations, and mortality of the fetuses.


RESULTS
Atrial flutter accounted for 26.2% of all cases of fetal tachyarrhythmias, and supraventricular tachycardia for 73.2%. Hydrops fetalis was reported in 38.6% and 40.5% of fetuses with atrial flutter and supraventricular tachycardia, respectively (NS). Hydropic fetuses with atrial flutter had higher ventricular rates (median 240 beats/min, range 240-300) than non-hydropic fetuses (220 beats/min, range 200-310) (p = 0.02), whereas the atrial rates were not significantly different (median 450 beats/min, range 370-500). Digoxin treatment resulted in a higher conversion rate in non-hydropic fetuses with fetal tachyarrhythmias than in hydropic fetuses (p < 0.001). The overall mortality of atrial flutter was similar to that of supraventricular tachycardia, at 8.0% v 8.9% (p = 0.7).


CONCLUSIONS
The prevalence of hydrops fetalis did not differ in fetal atrial flutter and supraventricular tachycardia with 1:1 conduction. There was no difference between the response rate to digoxin in fetus with atrial flutter or supraventricular tachycardia. Mortality was similar in the two types of tachyarrhythmia.
Krapp
M
M
Division of Prenatal Medicine, Department of Obstetrics and Gynaecology, University of Lübeck, Germany. drmartinkrapp@web.de
Kohl
T
T
Simpson
J M
JM
Sharland
G K
GK
Katalinic
A
A
Gembruch
U
U
D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001282:Atrial Flutter / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D004077:Digoxin / Q000627:therapeutic use; D005315:Fetal Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006327:Heart Block / Q000175:diagnosis; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis; D011181:Postnatal Care / Q000379:methods; D011295:Prenatal Care / Q000379:methods; D011296:Prenatal Diagnosis / Q000379:methods; D011379:Prognosis; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000628:therapy
D000889:Anti-Arrhythmia Agents; D004077:Digoxin