title: [Fetal bradycardia: a retrospective study in 9 Spanish centers].
abstract: OBJECTIVE
  The aim of this study is to review the current management and outcomes of fetal bradycardia in 9 Spanish centers.
  
  
  METHODS
  Retrospective multicenter study: analysis of all fetuses with bradycardia diagnosed between January 2008 and September 2010. Underlying mechanisms of fetal bradyarrhythmias were studied with echocardiography.
  
  
  RESULTS
  A total of 37 cases were registered: 3 sinus bradycardia, 15 blocked atrial bigeminy, and 19 high grade atrioventricular blocks. Sinus bradycardia: 3 cases (100%) were associated with serious diseases. Blocked atrial bigeminy had an excellent outcome, except for one case with post-natal tachyarrhythmia. Of the atrioventricular blocks, 16% were related to congenital heart defects with isomerism, 63% related to the presence of maternal SSA/Ro antibodies, and 21% had unclear etiology. Overall mortality was 20% (37%, if terminations of pregnancy are taken into account). Risk factors for mortality were congenital heart disease, hydrops and/or ventricular dysfunction. Management strategies differed among centers. Steroids were administrated in 73% of immune-mediated atrioventricular blocks, including the only immune-mediated IInd grade block. More than half (58%) of atrioventricular blocks had a pacemaker implanted in a follow-up of 18 months.
  
  
  CONCLUSIONS
  Sustained fetal bradycardia requires a comprehensive study in all cases, including those with sinus bradycardia. Blocked atrial bigeminy has a good prognosis, but tachyarrhythmias may develop. Heart block has significant mortality and morbidity rates, and its management is still highly controversial.
authors.affiliation: Unidad de Cardiología Pediátrica, Hospital Universitario Virgen de las Nieves, Granada, España. Electronic address: francescaperin33@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Perin
authors.affiliation: Unidad de Cardiología Pediátrica, Hospital Universitario Virgen de las Nieves, Granada, España.
authors.forename: M M
authors.initials: MM
authors.lastname: Rodríguez Vázquez del Rey
authors.affiliation: Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Deiros Bronte
authors.affiliation: Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, España.
authors.forename: Q
authors.initials: Q
authors.lastname: Ferrer Menduiña
authors.affiliation: Unidad Médico-Quirúrgica de Cardiopatías Congénitas, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
authors.forename: F
authors.initials: F
authors.lastname: Rueda Nuñez
authors.affiliation: Sección de Cardiología Pediátrica, Hospital Universitario Carlos Haya, Málaga, España.
authors.forename: J I
authors.initials: JI
authors.lastname: Zabala Arguelles
authors.affiliation: Unidad de Cardiología Pediátrica, Hospital Universitario Miguel Servet, Zaragoza, España.
authors.forename: D
authors.initials: D
authors.lastname: García de la Calzada
authors.affiliation: Unidad de Cardiología Pediátrica, Hospital Universitario de Sabadell, Sabadell, Barcelona, España.
authors.forename: S
authors.initials: S
authors.lastname: Teodoro Marin
authors.affiliation: Unidad de Cardiología Pediátrica, Hospital Universitario Río Hortega, Valladolid, España.
authors.forename: F
authors.initials: F
authors.lastname: Centeno Malfaz
authors.affiliation: Unidad de Medicina Fetal, Servicio de Obstetricia y Ginecología, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Galindo Izquierdo
mesh_terms: D001919:Bradycardia / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012189:Retrospective Studies; D013030:Spain
keywords: Bloqueo auriculoventricular; Bradicardia; Bradycardia; Corticoides; Fetal therapy; Heart block; Steroids; Terapia fetal
vernacular_title: Bradicardia fetal: estudio multicéntrico retrospectivo en 9 hospitales españoles.