Korean J Obstet Gynecol.  2011 Jul;54(7):369-372. 10.5468/KJOG.2011.54.7.369.

A fetal supraventricular tachycardia which converted from blocked premature atrial contractions

• Lim JH
• Choi JY
• Sung HI
• Ji I
• Han HS

• KMID: 2274051
• DOI: http://doi.org/10.5468/KJOG.2011.54.7.369

Abstract

We are reporting a case of fetal supraventricular tachycardia (SVT) which converted from blocked premature atrial contractions (PAC). It has been treated by verapamil in utero. We suggest that fetal PACs are usually benign phenomena which resolve spontaneously, but require some follow-up to exclude the development of SVT. SVT is rare but complicated by fetal congestive heart failure or even fetal death.

Keyword

Tachycardia, supraventricular; Atrial premature complexes

MeSH Terms

Atrial Premature Complexes
Fetal Death
Follow-Up Studies
Heart Failure
Tachycardia, Supraventricular
Verapamil
Verapamil

Figure

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  Fig. 1. Pulse Doppler shows skipped beats and M-mode reveals blocked premature atrial contractions (PAC).

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  Fig. 2. M-mode shows supraventricular tachycardia which beats 234 per minutes.

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  Fig. 3. Heart rate is 216 beats per minute but skipped beats in every 2 to 5 beats.

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  Fig. 4. Fetal heart rate returned normal (143 beats per minute [BPM]) by Verapamil and the baby has normal regular heart rate (135 BPM) without medication.

Reference

1. Simpson JM, Milburn A, Yates RW, Maxwell DJ, Sharland GK. Outcome of intermittent tachyarrhythmias in the fetus. Pediatr Cardiol. 1997; 18:78–82.

2. Alvarez A, Vial Y, Mivelaz Y, Di Bernardo S, Sekarski N, Meijboom EJ. Fetal arrhythmias: premature atrial contractions and supraventricular tachycardia. Rev Med Suisse. 2008; 4:1724–8.

3. Kleinman CS. Prenatal diagnosis and management of intrauterine arrhythmias. Fetal Ther. 1986; 1:92–5.

4. van Engelen AD, Weijtens O, Brenner JI, Kleinman CS, Copel JA, Stoutenbeek P, et al. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol. 1994; 24:1371–5.

5. Azancot-Benisty A, Jacqz-Aigrain E, Guirgis NM, Decrepy A, Oury JF, Blot P. Clinical and pharmacologic study of fetal supraventricular tachyarrhythmias. J Pediatr. 1992; 121:608–13.

6. Gulamhusein S, Ko P, Carruthers SG, Klein GJ. Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil. Circulation. 1982; 65:348–54.

7. Shin BS, Cho Y, Ro ES, Lee DO, Mun KS. A case of fetal supraventricular tachycardia with fetal ascites treated by antiarrhythmic agent. Korean J Obstet Gynecol. 2004; 47:1794–9.

8. Reed KL. Introduction to fetal echocardiography. Obstet Gynecol Clin North Am. 1991; 18:811–22.

9. Oudijk MA, Gooskens RH, Stoutenbeek P, De Vries LS, Visser GH, Meijboom EJ. Neurological outcome of children who were treated for fetal tachycardia complicated by hydrops. Ultrasound Obstet Gynecol. 2004; 24:154–8.

10. Hansmann M, Gembruch U, Bald R, Manz M, Redel DA. Fetal tachyarrhythmias: transplacental and direct treatment of the fetus-a report of 60 cases. Ultrasound Obstet Gynecol. 1991; 1:162–8.