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Yuan SM. Fetal Arrhythmias: Genetic Background and Clinical Implications. Pediatr Cardiol 2019; 40:247-256. [PMID: 30478614 DOI: 10.1007/s00246-018-2008-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023]
Abstract
Fetal arrhythmias are a common phenomenon of pregnancies. However, debates remain with regard to the etiologies and early treatment of choices for severe fetal arrhythmias. The gene regulatory networks govern cardiac conduction system development to produce distinct nodal and fast conduction phenotypes. The slow conduction properties of nodes that display automaticity are determined by the cardiac ion channel genes, whereas the fast conduction properties are regulated by the transcription factors. Mutations of genes specific for the developmental processes and/or functional status of cardiac conduction system including ion channel promoter (minK-lacZ), GATA family of zinc finger proteins (GATA4), the homeodomain transcription factor (Nkx2.5), the homeodomain-only protein (Hop) and the T-box transcription factors (Tbx2, Tbx3 and Tbx5), hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4) and connexins, may cause fetal arrhythmias. It is expected that development of investigational antiarrhythmic agents based on genetic researches on cardiac conduction system, and clinical application of percutaneously implantable fetal pacemaker for the treatment of fetal arrhythmias would come to true.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, 389 Longdejing Street, Chengxiang District, Putian, 351100, Fujian Province, People's Republic of China.
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2
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Yuan SM. Fetal arrhythmias: Surveillance and management. Hellenic J Cardiol 2018; 60:72-81. [PMID: 30576831 DOI: 10.1016/j.hjc.2018.12.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022] Open
Abstract
Fetal arrhythmias warrant sophisticated surveillance and management, especially for the high-risk pregnancies. Clinically, fetal arrhythmias can be categorized into 3 types: premature contractions, tachyarrhythmias, and bradyarrhythmias. Fetal arrhythmias include electrocardiography, cardiotocography, echocardiography and magnetocardiography. Oxygen saturation monitoring can be an effective way of fetal surveillance for congenital complete AV block or SVT during labor. Genetic surveillance of fetal arrhythmias may facilitate the understanding of the mechanisms of the arrhythmias and provide theoretical basis for diagnosis and treatment. For fetal benign arrhythmias, usually no treatment but a close follow-up is need, while persistant fetal arrhythmias with congestive heart dysfunction or hydrops fetalis, intrauterine or postnatal treatments are required. The prognoses of fetal arrhythmias depend on the type and severity of fetal arrhythmias and the associated fetal conditions. Responses of fetal arrhythmias to individual treatments and clinical schemes are heterogeneous, and the prognoses are poor particularly under such circumstances.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People's Republic of China.
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Cornacchini G, Pedro B, Martin M, Mair A. Cardioversion of suspected vagally mediated atrial flutter using lidocaine in an anaesthetised dog. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2018-000591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Brigite Pedro
- CardiologyWillows Veterinary Centre and Referral CentreSolihullWest MidlandsUK
| | - Mike Martin
- CardiologyWillows Veterinary Centre and Referral ServiceSolihullWest MidlandsUK
| | - Alastair Mair
- AnaesthesiaWillows Veterinary Centre and Referral CentreSolihullWest MidlandsUK
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Gordon GH, Thomas J, Trampe B, Iruretagoyena JI. Foetal premature atrial contractions during the second and third trimester are not associated with foetal breathing. J OBSTET GYNAECOL 2017; 37:742-745. [PMID: 28502200 DOI: 10.1080/01443615.2017.1306693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Foetal premature atrial contractions (PACs) are the most commonly encountered and also the most benign foetal arrhythmia. A retrospective cohort study was conducted with the objective to assess whether the presence of foetal breathing was associated with the presence of foetal PACs. A further objective was to evaluate whether this association would affect neonatal outcomes at a high volume referral centre. The diagnosis of PACs was based on the observation of a premature atrial contraction followed by a ventricular contraction on ultrasound myocardial M-mode. Trained ultrasonographers documented in the ultrasound report whether or not foetal breathing was present with PACs. 91 exams were identified, which included 75 individual pregnancies. Six women were identified who had foetal PACs associated with foetal breathing on ultrasound evaluation. Foetuses with PACs did not differ between the associated breathing and no-associated breathing groups with respect to maternal age, parity, mode of delivery, gestational age at delivery or birthweight. This study reaffirms that isolated PACs are a benign finding. Furthermore, it adds to the pool of literature on foetal PACs in that it is not associated with abnormal pregnancy outcomes regardless of the presence or absence of foetal breathing. Impact statement • What is already known on this subjectSince foetal breathing can effect Doppler ultrasound assessment of the foetal cardiovascular system, it is reasonable to consider that it may impact conditions such as foetal arrhythmias. • What the results of this study addFoetal breathing does not impact on the presence of premature atrial contractions. • What the implications are of these findings for clinical practice and/or further researchFoetal breathing is not associated with the finding of foetal premature atrial contractions.
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Affiliation(s)
- Geoffrey H Gordon
- a Department of OB/GYN, Division Maternal-Fetal Medicine , University of Wisconsin School of Medicine and Public Health
| | - Joelle Thomas
- b Department of Obstetrics & Gynecology , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - Barbara Trampe
- b Department of Obstetrics & Gynecology , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA
| | - J I Iruretagoyena
- a Department of OB/GYN, Division Maternal-Fetal Medicine , University of Wisconsin School of Medicine and Public Health
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Perles Z, Gavri S, Rein AJ. Tachyarrhythmias in the fetus: State of the art diagnosis and treatment. PROGRESS IN PEDIATRIC CARDIOLOGY 2006. [DOI: 10.1016/j.ppedcard.2006.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Life-threatening fetal arrhythmias are rare and warrant sophisticated specialty prenatal care, often provided by maternal-fetal medicine obstetricians, and pediatric and adult cardiologists. This medical field is in quick transition, and new methods of diagnosis and treatment of the fetus with arrhythmias are emerging. In this article, the mechanisms of arrhythmias are presented in light of recent progress in the new field of fetal electrophysiology. Treatments are reviewed with recommendations based on the small number of series of fetal tachycardia and fetal atrioventricular (AV) block drug treatment strategies published to date. Finally, a summary of areas of potential future research is provided.
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Affiliation(s)
- Janette F Strasburger
- Medical College of Wisconsin, and Children's Hospital of Wisconsin, 9000 West Wisconsin Avenue, MS 713, Milwaukee, WI 53201, USA.
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Wakai RT. Assessment of fetal neurodevelopment via fetal magnetocardiography. Exp Neurol 2004; 190 Suppl 1:S65-71. [PMID: 15498544 DOI: 10.1016/j.expneurol.2004.04.019] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Revised: 04/04/2004] [Accepted: 04/22/2004] [Indexed: 11/20/2022]
Abstract
Fetal magnetocardiography (fMCG) offers unique capabilities for assessment of fetal heart rate (FHR) and fetal behavior, which are fundamental aspects of neurodevelopment. The most important attribute of fMCG for FHR monitoring is its high precision, which allows accurate assessment of beat-to-beat fetal heart rate variability (FHRV), including respiratory sinus arrhythmia. Using mathematical indices to assess FHRV, we find that short- and long-term FHRV both increase during gestation but not in the same manner. The largest increases in short-term FHRV occur during the last trimester, while the largest increases in long-term FHRV occur early on, with smaller changes occurring during the last trimester. The fMCG also allows assessment of fetal activity. This results from the high sensitivity of the signal to the position and orientation of the fetal heart. FMCG actograms are therefore specific for fetal trunk movement, which are thought to be more important than isolated extremity movements and other small fetal movements. The ability to assess FHR, FHRV, and fetal trunk movement simultaneously makes fMCG a valuable tool for neurodevelopment research.
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Affiliation(s)
- Ronald T Wakai
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53706, USA.
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van Leeuwen P, Lange S, Klein A, Geue D, Grönemeyer DHW. Dependency of magnetocardiographically determined fetal cardiac time intervals on gestational age, gender and postnatal biometrics in healthy pregnancies. BMC Pregnancy Childbirth 2004; 4:6. [PMID: 15061871 PMCID: PMC411040 DOI: 10.1186/1471-2393-4-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 04/02/2004] [Indexed: 11/21/2022] Open
Abstract
Background Magnetocardiography enables the precise determination of fetal cardiac time intervals (CTI) as early as the second trimester of pregnancy. It has been shown that fetal CTI change in course of gestation. The aim of this work was to investigate the dependency of fetal CTI on gestational age, gender and postnatal biometric data in a substantial sample of subjects during normal pregnancy. Methods A total of 230 fetal magnetocardiograms were obtained in 47 healthy fetuses between the 15th and 42nd week of gestation. In each recording, after subtraction of the maternal cardiac artifact and the identification of fetal beats, fetal PQRST courses were signal averaged. On the basis of therein detected wave onsets and ends, the following CTI were determined: P wave, PR interval, PQ interval, QRS complex, ST segment, T wave, QT and QTc interval. Using regression analysis, the dependency of the CTI were examined with respect to gestational age, gender and postnatal biometric data. Results Atrioventricular conduction and ventricular depolarization times could be determined dependably whereas the T wave was often difficult to detect. Linear and nonlinear regression analysis established strong dependency on age for the P wave and QRS complex (r2 = 0.67, p < 0.001 and r2 = 0.66, p < 0.001) as well as an identifiable trend for the PR and PQ intervals (r2 = 0.21, p < 0.001 and r2 = 0.13, p < 0.001). Gender differences were found only for the QRS complex from the 31st week onward (p < 0.05). The influence on the P wave or QRS complex of biometric data, collected in a subgroup in whom recordings were available within 1 week of birth, did not display statistical significance. Conclusion We conclude that 1) from approximately the 18th week to term, fetal CTI which quantify depolarization times can be reliably determined using magnetocardiography, 2) the P wave and QRS complex duration show a high dependency on age which to a large part reflects fetal growth and 3) fetal gender plays a role in QRS complex duration in the third trimester. Fetal development is thus in part reflected in the CTI and may be useful in the identification of intrauterine growth retardation.
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Affiliation(s)
- Peter van Leeuwen
- Department of Biomagnetism, Research and Development Center for Microtherapy (EFMT), Universitätsstr. 142, 44799 Bochum, Germany
| | - Silke Lange
- Department of Biomagnetism, Research and Development Center for Microtherapy (EFMT), Universitätsstr. 142, 44799 Bochum, Germany
| | - Anita Klein
- Department of Biomagnetism, Research and Development Center for Microtherapy (EFMT), Universitätsstr. 142, 44799 Bochum, Germany
| | - Daniel Geue
- Department of Biomagnetism, Research and Development Center for Microtherapy (EFMT), Universitätsstr. 142, 44799 Bochum, Germany
| | - Dietrich HW Grönemeyer
- Grönemeyer Institute for Microtherapy, University of Witten/Herdecke, Universitätsstr. 142, 44799 Bochum, Germany
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Hosono T, Chiba Y, Shinto M, Miyashita S, Muramaki K, Kandori A, Tsukada K. A case of fetal complete heart block recorded by magnetocardiography, ultrasonography and direct fetal electrocardiography. Fetal Diagn Ther 2001; 16:38-41. [PMID: 11125250 DOI: 10.1159/000053878] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Fetal magnetocardiograms (FMCGs) were recorded in a case of fetal complete heart block (CHB) from the 30th to the 37th week of gestation using the multichannel SQUID system (Hitachi, Japan). M-mode ultrasonography and direct fetal electrocardiography using needle electrodes revealed fetal CHB. We identified independent fetal P-waves and QRS complexes in the FMCG recorded in the 32nd week of gestation when the fetal atriums were close to the FMCG sensor. We also recorded FMCG P-waves in the 37th week of gestation when the fetal heart was larger. Fetal heart position and size are important for obtaining a useful FMCG. To establish FMCG as a diagnostic tool of fetal arrhythmia, comparative studies with FECG are needed.
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Affiliation(s)
- T Hosono
- Department of Perinatology, National Cardiovascular Center, Suita, Osaka, Japan.
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Menéndez T, Achenbach S, Beinder E, Hofbeck M, Schmid O, Singer H, Moshage W, Daniel WG. Prenatal diagnosis of QT prolongation by magnetocardiography. Pacing Clin Electrophysiol 2000; 23:1305-7. [PMID: 10962758 DOI: 10.1111/j.1540-8159.2000.tb00950.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Magnetocardiography constitutes a new tool for monitoring fetal cardiac activity. The fetal magnetocardiogram (FMCG) recorded noninvasively over the maternal abdomen is detectable with high temporal resolution and permits analysis of all parts of the PQRST waveform. In this way measurements of cardiac time intervals, including the QT interval, become possible. The following article constitutes the first report of antenatal detection of QT prolongation in two fetuses by FMCG.
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Affiliation(s)
- T Menéndez
- Department of Internal Medicine II, University of Erlangen-Nürnberg, Germany.
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van Leeuwen P, Hailer B, Bader W, Geissler J, Trowitzsch E, Grönemeyer DH. Magnetocardiography in the diagnosis of fetal arrhythmia. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:1200-8. [PMID: 10549968 DOI: 10.1111/j.1471-0528.1999.tb08149.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the possible use of magnetocardiography in the diagnosis of fetal arrhythmias. DESIGN Investigation of routinely examined pregnant women, as well as women referred because of arrhythmias or other reasons. PARTICIPANTS Sixty-three women between the 13th and 42nd week of pregnancy. METHODS Recording of 189 fetal magnetocardiograms, of which 173 traces (92%) demonstrated sufficient fetal signal strength to permit evaluation. After digital subtraction of the maternal artefact, all fetal complexes were identified and the recording was examined for arrhythmic events. RESULTS Short bradycardic episodes, not associated with any pathological condition, were found in 26% of all recordings, usually in mid-pregnancy. In 12 cases, isolated extrasystoles of no clinical importance could be identified. There were nine traces which revealed multiple arrhythmias including ventricular and supraventricular ectopic beats, bigeminy and trigeminy, sino-atrial block and atrio-ventricular conduction disturbances. Furthermore, two cases with tachycardia were found. CONCLUSION Magnetocardiography offers a simple noninvasive method for examination of the fetal cardiac electrophysiological signal. It may thus be useful in the identification and classification of clinically relevant arrhythmia and aid in decisions concerning treatment.
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Affiliation(s)
- P van Leeuwen
- Department of Biomagnetism, Research and Development Center for Microtherapy, Bochum, Germany
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Leuthold A, Wakai RT, Martin CB. Noninvasive in utero assessment of PR and QRS intervals from the fetal magnetocardiogram. Early Hum Dev 1999; 54:235-43. [PMID: 10321790 DOI: 10.1016/s0378-3782(98)00100-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Fetal cardiac waveform intervals were assessed from fetal magnetocardiogram (FMCG) recordings taken from 59 pregnant women at 17-41 weeks gestation. Beyond 27 weeks' gestation PR and QRS intervals, measured from averaged waveforms, could be obtained from all subjects; however, prior to 21 weeks' gestation the success rate was 50% or less due to low signal-to-noise ratio. QT interval could not be assessed accurately in most subjects. Weak, but statistically significant, correlations with gestational age were found for PR interval (n = 145, R2 = 0.033, P = 0.028) and QRS interval (n = 145, R2 = 0.140, P < 0.0005). Abnormal waveform morphology was documented in several patients with cardiac malformations.
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Affiliation(s)
- A Leuthold
- Department of Medical Physics, University of Wisconsin-Madison, 53706, USA
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Esperer HD. Has magnetocardiography a clinical future? Herzschrittmacherther Elektrophysiol 1997; 8:145-147. [PMID: 19484510 DOI: 10.1007/bf03042396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- H D Esperer
- Angiologie-Pneumologie-im Zentrum Innere Medizin, Otto-von-Guericke-Universität Klinik für Kardiologie, 39120, Magdeburg,
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Esperer HD. [Has the magnetocardiography a clinical future?]. Herzschrittmacherther Elektrophysiol 1997; 8:141-144. [PMID: 19484509 DOI: 10.1007/bf03042395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- H D Esperer
- Angiologie-Pneumologie-im Zentrum Innere Medizin, Otto-von-Guericke-Universität Klinik für Kardiologie, Leipziger Strasse 44, 39120, Magdeburg,
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