Fetal Arrhythmies

fetal arrhythmies<br />

Management of Fetal Arrhythmies

        The persistents major ipo or ipercinetic arrhythmies could constitute
        a condition of "cardiological fetal emergency" and if
        not in relief and promptly takes care of could conduct the fetus to heart
        failure and intrauterine death .The worse prognosis when the arrhythmy
        joins congenital heart disease (CHD).

        The most common form of ipercinetic arrhythmies is the supraventricular
        paroxysmal form that in the 10% of the cases join to structural CHD. The
        form that imposes a medical treatment the incessant one that it join to
        heart failure and/or CHD. Less frequent the atrial flutter or fibrillation
        or ventricular tachicardia.

        Between the ipocinetic arrhythmies the most remarkable is the complete
        a-v block whose prognosis tied to the ventricular frequency . When the
        ventricular frequency is < to 50 p.m. sever heart failure is the rule
        and having tried a trans-abdominal pacing without positive effect. This
        therapeutic approach would be desirable but for a prolonged stimulation
        the risk of infections fetal is very elevated . The literature brings again
        cases sporadic treatises without success with beta stimulating agent (
        isoproterenol,ritrodin etc)

        The most commonly drugs used are listed in the following chart.

        Transplacental Treatment of Fetal Arrhythmies
        Drugs ose Maintenance dose
        Digoxin g. os0.5 – 2 mg. e.v. 0.25 – 1 mg/die os
        Propranolol mg e.v. ( 0.04 mg/kg ) 80 – 160 mg/die os
        Verapamil e.v. 240 – 360 mg/die os
        Procainamid e.v. 3 – 4 gr/die os
        Quinidine os 1-2 gr/die os
        Flecainid e.v. 300 mg/die os
        Amiodarone os 600 mg/die os
        Betamimetics **) without effects.

        **) Fetal heart block may be treated with a loading test dose of Salbutamol e.v. 80 mg/L dextrose 4% solution starting
        with 4 micrograms/min and increased to 64 micrograms/min during the trial and
        followed by Salbutamol os 8 mg twice a day until delivery.(Groves and coll.Circ.92:3394:1995)

        In heart block with maternal anti-Ro and/or anti La proteins autoantibodies
        has been used Dexamethasone to the mother dosing 4 mg os once a day mantained until delivery,
        (Copel et al.:Am J obstet Gynecol 1384:173:1995)

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