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Fetal cardiac arrhythmia: new diagnostic options. (Magnetocardiography, Pulsed Doppler).
NEW YORK -- M-mode echocardiography, pulsed Doppler, and fetal magnetocardiography have the potential to revolutionize diagnosis of fetal cardiac arrhythmias, but like many advances in diagnostic technology they will likely leave clinicians wondering what to do about what they discover.
Though they are based on different technology, both M-mode echocardiography and the newer magnetocardiography allow for precise monitoring of atrial, ventriculer, and septal wall activity making it possible to get a far more accurate sense of what is happening in the fetal heart, Dr. Charles Kleinman explained at an ob.gyn. symposium sponsored by Columbia University and Sloane Hospital for Women.
But the treatment of fetal arrhythmias is complex, since it involves giving a pregnant woman antiarrhythmic drugs. There is a lack of consensus on the indications for treatment.
Fetal arrhythmias are defined as any irregularity of fetal heart rhythm or any regular rhythm outside of the range of 100160 beats/minute, said Dr. Kleinman, professor of clinical pediatrics in obstetrics and gynecology at Columbia University New York.
Hemodynamically significant fetal arrhythmias are hardly commonplace, but they aren't rare. The largest study of the scope of the problem was published in 2000 and based on evaluation of 4,838 fetuses at a Yale University clinic between 1988 and 1997. Of these, 12% were referred for evaluation of arrhythmias. The investigators found 55% were in sinus rhythm and 43% had isolated extrasystoles. Ten had hemodynamically significant problems, and of these nine survived. Two of the 10 fetuses had cardiac structural abnormalities.
Dr. Kleinman stressed that a rhythm disturbance is by no means an absolute indication that there is a structural abnormality and in the majority of cases, an irregular rhythm is intermittent or resolves spontaneously.
Sustained fetal arrhythmias tend to be atrial. "We seldom see ventricular tachycardia in a fetus," he said.
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Source: HighBeam Research, Fetal cardiac arrhythmia: new diagnostic options....