title: Doppler echocardiographic isovolumetric time intervals in diagnosis of fetal blocked atrial bigeminy and 2:1 atrioventricular block.
abstract: OBJECTIVE
  To distinguish between blocked atrial bigeminy (BB) and incomplete atrioventricular block with 2:1 conduction (2:1 AVB) can be very difficult, especially in the mid-term fetus. Making a correct diagnosis has important clinical implications, as their prognosis and management differ markedly. Our objective was to investigate whether analysis of isovolumetric time intervals could improve Doppler echocardiography in differentiating these conditions.
  
  
  METHODS
  Sixteen fetuses with sustained BB or isolated 2:1 AVB, diagnosed at our tertiary center from 2002 to 2012, were reviewed retrospectively. Doppler recordings of left ventricular in- and outflow, including mitral and aortic valve movements, were used to measure isovolumetric contraction (ICT) and relaxation (IRT) time intervals. ICT reference values obtained from 104 normal pregnancies were used for comparison.
  
  
  RESULTS
  Ten fetuses had BB and six 2:1 AVB. Five of the AVB cases were anti-Ro antibody positive and one had long QT syndrome (LQTS). ICT was systematically shorter in BB than in antibody-mediated 2:1 AVB. Nine of 10 cases with BB had an ICT below -2 SD and the five with antibody-mediated 2:1 AVB had values at or above +2 SD. All 15 fetuses with either BB or antibody-mediated AVB had an IRT of < 70 ms, as opposed to a markedly prolonged IRT (105 ms) in the LQTS case.
  
  
  CONCLUSIONS
  Measurement of ICT can improve the differential diagnosis between BB and antibody-mediated 2:1 AVB. Fetuses with BB or antibody-mediated AVB are unlikely to have IRT measurements exceeding 70 ms and, when this is observed, LQTS should be considered a more likely diagnosis.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: S-E
authors.initials: SE
authors.lastname: Sonesson
authors.forename: H
authors.initials: H
authors.lastname: Eliasson
authors.forename: P
authors.initials: P
authors.lastname: Conner
authors.forename: M
authors.initials: M
authors.lastname: Wahren-Herlenius
mesh_terms: D018880:Atrial Premature Complexes / Q000000981:diagnostic imaging* / Q000503:physiopathology; D054537:Atrioventricular Block / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001919:Bradycardia / Q000000981:diagnostic imaging / Q000503:physiopathology; D003937:Diagnosis, Differential; D004452:Echocardiography; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005318:Fetal Heart / Q000503:physiopathology*; D005333:Fetus; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D018617:Ultrasonography, Doppler, Pulsed
keywords: LQTS; arrhythmia; atrial bigeminy; bradycardia; congenital heart block; fetus