The challenge of fetal dysrhythmias: Echocardiographic diagnosis and clinical management

Michele D'Alto, Maria Giovanna Russo, Dario Paladini, Giovanni Di Salvo, Emanuele Romeo, Concetta Ricci, Maria Felicetti, Antonio Tartaglione, Dominga Cardaropoli, Giuseppe Pacileo, Berardo Sarubbi, Raffaele Calabrò

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: The present study aimed to evaluate the management of fetal cardiac dysrhythmias based on prior identification of the underlying electrophysiological mechanism. METHODS: We studied 36 consecutive fetuses with cardiac dysrhythmia. Rhythm diagnosis was based on M-mode, pulsed wave Doppler and tissue Doppler imaging (TDI). Only fetuses with: (i) incessant tachycardia (> 12 h) and mean ventricular rate > 200 beats/min, (ii) signs of left ventricular dysfunction, or (iii) hydrops, were treated using oral maternal drug therapy. RESULTS: The mean gestational age at diagnosis was 24.3 ± 4.5 weeks. Twenty-one fetuses had tachycardia with a 1: 1 atrial-ventricular (AV) conduction. Based on ventricular-atrial interval, prenatal diagnosis was: permanent junctional reciprocating (n = 6), atrial ectopic (n = 6) or atrial-ventricular re-entry tachycardia (n = 9). One had atrial flutter, one ventricular tachycardia and four congenital AV block. Nine showed premature atrial or ventricular beats. Fifteen fetuses with incessant tachycardia, left ventricular dysfunction or hydrops were prenatally treated with maternal administration of digoxin, sotalol or flecainide. The total success rate (sinus rhythm or rate control) was 14/15 (93%). Seven fetuses were hydropics. Three of these died (one at 28 weeks of gestation, two in the first week of life). The prenatal diagnosis of dysrhythmia was confirmed at the birth in 31 of 35 live-born. No misdiagnosis was made using TDI. At 3 ± 1.1-year follow-up, 33/35 children were alive and well. CONCLUSIONS: Fetal echocardiography could clarify the electrophysiological mechanism of fetal cardiac dysrhythmias and guide the therapy.

Original languageEnglish
Pages (from-to)153-160
Number of pages8
JournalJournal of Cardiovascular Medicine
Issue number2
Publication statusPublished - Feb 2008


  • Diagnosis
  • Dysrhythmias
  • Fetal echocardiography
  • Therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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