Diagnosis and management of fetal bradyarrhythmias.
Complete atrioventricular block (CAVB) is the most common cause of persistent fetal bradycardia. In the presence of a structurally normal heart, it develops primarily in anti-Ro and anti-La positive antibody pregnancies after 20 weeks of gestation. There is a significant risk of perinatal demise, particularly in association with fetal hydrops, poor ventricular function, and heart rates < 55 beats/min. Transplacental treatment strategies are aimed at preventing or modulating these risk factors. Maternal administration of dexamethasone to mitigate or prevent concomitant myocardial inflammation, in combination with beta-stimulation for persistent fetal bradycardia < 55 beats/min to increase fetal cardiac output, has resulted in significantly improved fetal and neonatal outcomes without reversing CAVB.
Jaeggi
Edgar T
ET
Fetal Cardiac Program, Division of Cardiology, The Hospital for Sick Children, Toronto, Canada. ejaeggi@yahoo.com
Friedberg
Mark K
MK
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001919:Bradycardia / Q000175:diagnosis* / Q000196:embryology / Q000628:therapy*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods*; D006801:Humans; D011247:Pregnancy
D000889:Anti-Arrhythmia Agents