Before initiating therapy, it is important to correctly diagnose the type and mechanism of the underlying arrhythmia so that the proper therapeutic modalities can be implemented. Wellens HJJ, Conover MB, The ECG in emergency decision making, Philadelphia, New York: WB Saunders Company, Second edition, 2006. Blutgruppe, die in diesem Fall den Fetus offenbar vom Vater geerbt hat. Published content on this site is for information purposes and is not a substitute for professional medical advice. fetal supraventricular tachycardia (SVT) most common fetal tachyarrhythmia: accounts for 60-90% of cases; has a typical ventricular rate of ~230-280 beats per minute (bpm) 4; often associated with an accessory AV conduction pathway; fetal atrial flutter. Supraventricular or ventricular tachyarrhythmias can become more frequent or may develop for the first time during pregnancy.13 An increased incidence of cardiac arrhythmias has been reported during pregnancy in patients with and without identifiable heart disease.14 New onset or increased frequency of supraventricular or ventricular tachyarrhythmias has been reported during pregnancy in patients with pre-excitation syndromes or other causes.15 Increased sympathetic activity during pregnancy has been proposed as a mechanism for increased incidence of arrhythmias.1,16 The occurrence of cardiac tachyarrhythmias may also be related to physiological changes that occur during pregnancy, such as increased heart rate, decreased peripheral resistance and increased stroke volume.17 Lee et al.18 reported a low risk of first onset of paroxysmal supraventricular tachycardia (SVT) during pregnancy, with an incidence of 4%. Arrhythmien gehören zu den häufigsten kardiologischen Auffälligkeiten beim Feten. Lisowski LA, Verheijen PM, Benatar AA, et al., Atrial flutter in the perinatal age group: diagnosis, management and outcome, J Am Coll Vardiol, 2000;35:771–7. Meine Hebamme hatte diese bei unserer … Hansmann et al. Neither supraventricular nor ventricular tachyarrhythmias are uncommon during pregnancy.1,2 When they are diagnosed, patients, relatives and physicians are frequently worried about ectopic beats and sustained arrhythmias.3,4 One should question whether arrhythmias should be treated in the same way as they would be outside pregnancy because all commonly used antiarrhythmic drugs cross the placenta.5 The pharmacokinetics of drugs are altered in pregnancy and blood levels need to be checked to ensure maximum efficacy and avoid toxicity.6–8 The major concern about antiarrhythmic drug therapy during pregnancy is the potential adverse effects on the foetus. irregular fetal bradycardia.. The problem of foetal tachyarrhythmias is the risk of hydrops fetalis and subsequent death.47 SVTs are the most common foetal tachycardias, whereas other arrhythmias are observed less frequently. Management of cardiac arrest due to life-threatening ventricular tachyarrhythmias is essential to prevent sudden cardiac death in the mother and the foetus. Direct foetal treatment regimes have been used that consist of intraperitoneal and/or umbilical IV administrations of different drugs. described three cases with hydrops fetalis due to supraventricular tachyarrhythmias successfully treated with amiodarone and digoxin or the combination of digoxin, procainamide and propranolol.40. In general, acute therapy of arrhythmias during pregnancy is similar to that in the non-pregnant patient. It has a typical ventricular rate of 230-280 beats per minute (bpm) 1 and isoften associated with an accessory AV conduction pathway. Bei 24 Patientinnen handelte es sich um eine supraventrikuläre Tachykardie (SVT), bei 70 um eine Extrasystolie (ES), und bei 8 um eine kontinuierliche Bradykardie. Therefore, direct foetal therapy is highly effective in SVT and AFlut and will lead to foetal survival. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Neonaten von Müttern mit OSAS zählen die vorzeitige Geburt, häufigere Entbindung per Sectio caesarea, ein niedriges bzw. Frage vom 05.04.2005. The most common type of fetal tachycardia is supraventricular tachycardia (66–90%) followed by atrial flutter (10–30%) 12 - 15. Acute treatment should be initiated based on the underlying mechanism. Fetal arrhythmias are a rare but serious condition occurring in an estimated 1-2% of pregnancies. Radcliffe Cardiology is part of Radcliffe Medical Media, an independent publisher and the Radcliffe Group Ltd. In addition, umbilical drug administration allows not only direct treatment but also drug monitoring. Fetale Chirurgie bedeutet die Durchführung von operativen Eingriffen am Ungeborenen mit dem Ziel der intrauterinen Korrektur von Mißbildungen, die das Leben des Kindes bereits pränatal gefährden oder die postnatal den Tod oder … Fetal echocardiography, or Fetal echocardiogram, is the name of the test used to diagnose cardiac conditions in the fetal stage.Cardiac defects are amongst the most common birth defects. Mozo de Rosales F, Moreno J, Bodegas A, et al., Conversion of atrial fibrillation with ajmaline in a pregnant woman with Wolff-Parkinson-White syndrome, Eur J Obstetrics, 1994;56: 63–6. Clinical studies of verapamil in pregnant woman have not demonstrated adverse effects on either patient or foetus. 2 Mongiovì M, Pipitone S. Supraventricular tachycardia in fetus: how can we treat ? Anhidrose & Arrhythmie & Schmerz: Mögliche Ursachen sind unter anderem Fabry-Syndrom. Natale A, Davidson T, Geiger MJ, Newby K, Implantable cardioverter-defibrillators and pregnancy. Pagad SV, Barmade AB, Toal SC, et al., “Rescue” radiofrequency ablation for atrial tachycardia presenting as cardiomyopathy in pregnancy, Indian Heart J, 2004;56:245–7. Compared with other arrhythmias, the overall perinatal mortality rate is considered low at ~5-10% (particularly if there are no complications such as the development of hydrops fetalis). They are frequently intermittent and may disappear until delivery or the neonatal period.22,23 Foetal arrhythmias can carry a significant risk of morbidity and mortality, especially when arrhythmias cause hydrops fetalis, which is associated with foetal death or neurological damage.24,25 In 2003, in the Swiss prospective FETCH study there was an 11% incidence of arrhythmias in 433 foetal echocardiographic examinations (www.neonat.ch). Auflage. „adverse effects“ bei Ungeborenen bzw. Although several studies have shown some adverse effects (increase in myometrial tone, decrease of placental blood flow, foetal bradycardia), its use during the early stages of pregnancy is not associated with a significant increase in the incidence of foetal defects.4 Class III antiarrhythmic agents (sotalol, amiodarone) are very effective drugs in patients with ventricular tachyarrhythmias. Longer-acting agents (IV calcium channel blockers or cardioselective beta-blocking agents) are of limited value because of a possible increase of hypotensive and/or bradycardiac effects.10 In patients with AV nodal re-entrant tachycardia, IV calcium channel blockers are acceptable drugs. ), Fetal and neonatal cardiology, Philadelphia: WB Saunders Company, 1990:180–84. Types of tachycardia. Hrsg. Jaeggi E, Fouron JC, Drblik SP, Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome, J Pediatr, 1998;132:335–9. Die intrapartale Überwachung wurde mittels Dopplersonographie vorgenommen. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Julkunen H, Kaaja R, Siren MK, et al., Immune-mediated congenital heart block (CHB): identifying and counselling patients at risk for having children with CHB, Semin Arthritis Theum, 1998;28:97–106. In all pregnant patients with tachyarrhythmias, evaluation of the underlying aetiology and the degree of left ventricular function/dysfunction is essential. An analysis of 11 studies reported from 1991 to 2002 showed a foetal SVT as the underlying arrhythmia in 73.2% and AFlut in 26.2%.48 The incidence of hydrops fetalis was similar in those with AFlut or SVT (38.6 versus 40.5%; p=NS). Er meinte das Hezr würde sich aber noch entwickeln! Anderer G, Hellmeyer L, Tekesin I, Schmidt S, Kombinationstherapie einer fetalen supraventrikulären Tachykardie mit Flecainid und Digoxin, Z Geburtshilfe Neonatol, 2005;209:34–7. 1997;16 (7): 459-64. Although this drug is associated with few side effects, maternal hypothermia and foetal bradyarrhythmias have been observed.43 In a few cases, verapamil is effective in pregnant women with right/left ventricular outflow tachycardia.44, Life-threatening VF or VFlut can occur at any stage of pregnancy and is associated with a high risk of sudden cardiac death. Theodor Michael, Arpad Moers, Elisabeth Strehl, Hannes Haberl, Susanne Beck 2. With this in mind, a successful pregnancy, for both mother and foetus, can usually be the result. Verwenden Sie den Chatbot, um Ihre Suche weiter zu verfeinern. In patients who remain highly symptomatic, treatment with selective β-adrenergic-receptor-blocking agents should be considered. The advantage of adenosine 9–18mg intravenous (IV) as bolus relative to intravenous calcium antagonists or beta-blockers relates to its rapidity of onset and short half-life.34 In addition, the current reported human clinical experience with adenosine during pregnancy indicates no teratogenicity or other adverse effects to the foetus, and it is as effective in terminating SVT (efficacy rates >90%) in pregnant woman as it is in patients who are not pregnant. 3. Bei Aufnahme und unter der Geburt fielen schwere fetale Bradykardien auf. Bei manchen Menschen gerät der Herzschlag aus dem Takt: Der normale regelmäßige Sinusrhythmus schlägt um in eine Absolute Arrhythmie. Beta-blocking agents readily cross the placenta and could, in large doses, cause a relative foetal bradycardia. Fetal atrial flutter is the second most common fetal tachyarrhythmia and can account for up to 30% of such cases 1,2. War dann alles ok mit euren Mäusen nach der Geburt? However, special consideration should be given to potential teratogenic and haemodynamic adverse effects on the foetus. VT or ventricular fibrillation (VF) was not recorded in any of the patients.14. Currently, foetal echocardiography is the best method and remains the cornerstone for in utero diagnosis of arrhythmias.31 It has been shown that the electrophysiological mechanisms of foetal supraventricular tachyarrhythmias can be clarified with superior vena cava/aorta Doppler flow recordings.32 Cross-sectional echocardiography, M-mode and echo-Doppler have been used for differentiation of supraventricular from ventricular arrhythmias. If maternal therapy fails to suppress or sufficiently decrease the rate of foetal tachyarrhythmias, direct drug administration to the foetus is mandatory. Trappe, M. Tchirikov, Herzrhythmusstörungen bei der Schwangeren und beim FetusCardiac arrhythmias in the pregnant woman and the fetus, Der Internist, 10.1007/s00108-008-2072-5, 49, 7, (788-798), (2008). Fasnacht MS, Günthard J, Fetale Kardiologie beinhaltet nicht nur fetale Echokardiographie, Pediatrica, 2004;15:27–9. Check for errors and try again. In addition, the β-adrenergic properties of sotalol must be considered. Trappe HJ, Tchirikov M, Herzrhythmusstörungen bei der Schwangeren und beim Fetus, Internist, 2008;49:788–98. SS) die bei bekanntem hypoplastischem Links-Herz-Syndrom des Kindes spontan entbindet. Chow T, Galvin J, McGovern B, Antiarrhythmic drug therapy in pregnancy and lactation, Am J Cardiol, 1998;82:58I–62I. *Others include fetal arrhythmias, antidepressants, polyhydramnious, and Morbus Graves. All rights reserved. Ultrasound Diagnosis of Fetal Anomalies. One of the most important problems in intensive care, emergency medicine and cardiac rhythmology are pregnant patients with recurrent VT, ventricular flutter (VFlut) or VF. In many patients with narrow-QRS-complex tachycardia, the tachycardia rate is very high (180–240bpm); therefore, after onset of the tachycardia the patient will arrive very soon thereafter in an intensive care unit for diagnosis and treatment. In regular narrow-QRS-complex tachycardia (QRS width <0.12s), vagal manoeuvres should be initiated to terminate the arrhythmia or to modify AV conduction.21,33 If this fails, adenosine or calcium channel blockers (verapamil) are the drugs of first choice (see Figure 1). Fetal tachycardia is an abnormal increase in the fetal heart rate. The onset of the first episode was distributed equally over the three trimesters. Die Schwangeren zeigen in den häufigsten Fällen keine klinischen Auffälligkeiten. Hansmann M, Gembruch U, Bald R, et al., Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases, Ultrasound Obstet Gynecol, 1991;1:158–60. Fouron JC, Fournier A, Proulx F, et al., Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings, Heart, 2003;89:1211–16. Fetale Geburtsüberwachung durch Oxykardiotokographie (OCTG) December 1993; Geburtshilfe und Frauenheilkunde 53(12):849-853; DOI: 10.1055/s-2007-1023737. Wide-QRS-complex tachycardias (QRS duration >0.12s) often pose a difficult diagnostic and therapeutic problem.21 Errors are made because emergency care professionals wrongly consider VT unlikely if the patient is young and haemodynamically stable, and they are often unaware of the ECG findings that quickly and accurately distinguish VT in more than 90% of cases.