Dried umbilical cord is a potential material for retrospective diagnosis of intrauterine enterovirus infection.

OBJECTIVE: To determine whether dried umbilical cords (UCs) are useful for retrospective diagnosis of intrauterine enterovirus (EV) infection. METHODS: Dried UCs in two patients with neonatal EV sepsis and 10 neonates without infectious signs were enrolled. Viral RNA was extracted from their dried UCs, and nested reverse transcription polymerase chain reaction (RT-PCR) was performed. RESULTS: Infection routes estimated by the clinical course were intrauterine infection in Case 1 and post-natal horizontal infection in Case 2. EV-RNA was detected from dried UC in Case 1, but not in Case 2 and 10 neonates. CONCLUSIONS: This report showed the potential use of dried UCs for retrospective diagnosis of intrauterine EV infection.

Voltage and activation mapping: how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease.

BACKGROUND: Endocardial mapping is mandatory before radiofrequency catheter ablation (RFCA). Mapping can be performed with either unipolar or bipolar recordings. Impact of the recording technique used was studied in patients with and without structural heart disease using the 3D electroanatomic CARTO mapping system. METHODS AND RESULTS: Patients (n=44; 16 males; age 43+/-16 years) referred for RFCA of atrial flutter (AFL, n=18), focal atrial tachycardia (FAT, n=4), AV nodal reentrant tachycardia (AVNRT, n=5), or scar-related atrial reentrant tachycardia (IART, n=17) were studied. Voltage and activation maps were constructed. Unipolar and bipolar voltage distribution in the different groups was studied to establish a cutoff voltage value to facilitate delineation of scar tissue. Electrograms were recorded during tachycardia (FAT: n=246, cycle length [CL]=449+/-35 ms; AVNRT: n=182, CL=359+/-47 ms; AFL: n=1164, CL=255+/-56 ms; IART: n=2431, CL=280+/-74 ms). Unipolar voltages were greater than bipolar voltages (P<0.001). Unipolar voltages < or =1.0 mV were equally distributed in both AFL and IART patients. Bipolar voltages < or =0.1 mV were only found in patients with IART, and subsequently 0.1 mV was used as the cutoff value to delineate scar tissue. No unipolar cutoff value could be established. Timing of unipolar and bipolar local activation was correlated in all patient groups. CONCLUSIONS: The recording technique used has considerable impact on reconstruction of reentrant pathways and on the outcome of RFCA. In general, unipolar and bipolar recordings provide complementary information; however, only bipolar recordings allow voltage-based scar tissue delineation in patients with congenital heart disease.

Pericardial cystic mass with fetal tachycardia.

A pericardial cystic mass is a rare congenital anomaly and may be mistaken for other pericardial and pleural masses. A 31-year-old pregnant woman at 38 weeks of gestation presented with fetal pericardial cyst and fetal tachycardia, which were confirmed by transthoracal echocardiography after delivery. Tachycardia did not persist after delivery. The case is being followed up without any clinical problems at the pediatric cardiology clinic.

Familial neonatal atrial tachycardia.

A father and his two sons each presented with atrial tachycardia in the newborn period. The father went on to develop dilated cardiomyopathy. The first son (who also had transposition of the great arteries) died from the arrhythmia after surgery. The second son is currently successfully managed pharmacologically.

Diagnosis and treatment of structural fetal cardiac abnormality and dysrhythmia.

Although a great deal of controversy surrounds the concept of routine ultrasound screening, 70% of pregnant women in this country undergo ultrasound examination. Assessment of the fetal heart including a four-chamber view is recommended when ultrasound scans in the second and third trimester are performed. The accurate diagnosis of structural heart disease and cardiac dysrhythmias is now possible with advances in ultrasound and fetal echocardiography. Increased prenatal screening and genetic counseling have improved the management of these complicated pregnancies. It is hoped that the detection of significant congenital heart disease will continue to increase leading to further advances in medical and surgical treatment, improved patient care, and favorable perinatal outcomes.

Fetal arrhythmias.

The increased awareness of fetal arrhythmias by obstetricians and the development of sophisticated fetal echocardiography have established the basis for identification and treatment of these arrhythmias. The development of fetal hydrops is a recognized link to the severity of the arrhythmia. Fetal tachycardias have been diagnosed relatively early in gestation. They may be differentiated into sinus tachycardia, supraventricular tachycardia, atrial flutter or fibrillation, and ventricular tachycardia. The need for prenatal treatment is widely accepted and various modes of therapy are advocated. Oral maternal antiarrhythmic medication is often used, is considered convenient and safe, and provides adequate conversion. The drugs of choice at various centers have included digoxin, flecainide, amiodarone, and a host of combinations, as well as sotalol, which is gaining popularity. At birth, reentry mechanisms are often documented, with frequent relapses of tachycardia, warranting postpartum continuation of treatment. Fetal bradycardias consist of sinus bradycardia (generally related to obstetric pathology) and atrioventricular block. Atrioventricular block may occur secondary to severe congenital heart disease in the fetus or as an isolated phenomenon. The development of isolated total atrioventricular block has been seen to occur from a gestational age of 18 weeks up to term. It is invariably accompanied by the presence of SS-A and SS-B autoantibodies in the mother. Passage of these antibodies across the placenta causes inflammatory disease of fetal atrioventricular node tissue, resulting in fibrosis and atrioventricular block.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fetal arrhythmias--new immunologic studies and results]. / Fetale Arrhythmien--Neue Immunologische Untersuchungen und Ergebnisse.

The etiology of fetal arrhythmias is still unknown. We therefore did a research for immunologic causes: antimyolemmal antibodies (AMLA) in mothers and umbilical cord serum resulting from secondary immunopathogenesis caused by myocarditis of the mother. Is there a correlation between immunological and clinical findings giving a possible explanation for fetal arrhythmias? In 21 cases mothers and umbilical cord serum was investigated for AMLA; 16 with fetal atrial premature beats, 4 with fetal tachycardia and 1 with fetal bradyarrhythmia. From 16 mothers with fetal atrial premature beats had 12 AMLA, from these were in 4 cases in the umbilical cord serum AMLA. In 4 cases of fetal tachycardia we found in 1 case AMLA in mothers and umbilical cord serum. In the other 3 cases accessory pathways have been the cause for tachycardia. From 19 healthy persons were found in 3 cases AMLA in mothers serum, umbilical cord serum was negative.

Pediatric electrophysiology.

Our understanding of pediatric arrhythmias continues to evolve through natural history studies of paroxysmal supraventricular tachycardia, the congenital long QT syndrome, and postoperative atrial and ventricular tachyarrhythmias. The influence of the autonomic nervous system on cardiovascular function may play a role in the sudden infant death syndrome, pallid breath-holding spells, and neurally mediated syncope; much work is necessary to understand these entities better. Therapeutic approaches to pediatric arrhythmias are extending beyond newer antiarrhythmic drugs and now include ablative therapy for many supraventricular tachyarrhythmias, both surgical and transcatheter. Advances in pacemaker therapy include novel implantation sites, down-sizing of devices, and the application of antitachycardia and rate-adaptive technologies.

Evaluation of fetal cardiac arrhythmias. Ultrasound findings and neonatal outcome.

During a four-year period, 3,882 fetal diagnostic ultrasounds were performed and 162 patients (4% of all patients scanned) were referred to our perinatal center for evaluation of fetal cardiac arrhythmia. Fetal echocardiography subsequently revealed an arrhythmia in 80 (49%) of these patients. The rhythm disturbances noted were premature atrial or ventricular contractions (n = 65, 81%), tachyarrhythmia (n = 8, 10%), and bradyarrhythmia (n = 7, 9%). Three of the bradycardic fetuses evaluated had complete heart block associated with anatomic abnormalities. In seven tachycardic fetuses, the finding of fetal compromise was followed by intervention. The majority of fetuses with cardiac rhythm disturbance will have premature atrial or ventricular contractions and will have normal echocardiographic evaluation and neonatal outcome. Sustained tachyarrhythmias and bradyarrhythmias are more likely to be associated with fetal morbidity. Based upon the findings of this study and others, we propose a scheme for follow-up of the fetus referred with an irregular cardiac rhythm.

[Malignant ventricular arrhythmia in congenital aneurysms of the left ventricle in adulthood]. / Maligne ventrikuläre Arrhythmien bei kongenitalen Aneurysmen des linken Ventrikels im Erwachsenenalter.

Congenital aneurysms of the left ventricle (ALV) are rare cardiac lesions. Beyond that an association with malignant ventricular arrhythmias (MVA, symptomatic ventricular tachycardia--VT or ventricular fibrillation--VF) is reported only in sporadic cases. Since 1988 we had the opportunity to study 5 patients (pts) with MVA (4 sustained VT, 1 VF; 1 female, 4 males; mean age 38 years) without cardiovascular risk factors, history of myocardial infarction, trauma or inflammatory disease. Left ventricular contrast angiography and echocardiography disclosed ALV's. At programmed electrical stimulation clinically documented MVA (4 VT, 1 resuscitated VF) were reproducible in all 5 cases, the respective VT was located in the area of the ALV in 4 cases. In 2 pts aneurysmectomy combined with subendocardial resection and cryotherapy (1 apical, 1 posterobasal ALV) was performed. In both pts histopathology confirmed a congenital disorder, without evidence of inflammatory lesions. In 2 pts MVA was controlled with antiarrhythmic therapy. The pt with VF and an ALV adjacent to the anulus of the aortic valve received an implantable cardioverter defibrillator. In congenital aneurysms of the left ventricle complicated by malignant ventricular arrhythmias surgical intervention offers a potential cure in selected cases.

Successful treatment of chaotic atrial tachycardia with oral flecainide.

Two infants with chaotic atrial tachycardia diagnosed at birth and at 11 weeks of life, were treated successfully with oral flecainide. Both patients were in heart failure at initiation of therapy. Six months and 17 months later, respectively, they have had no recurrence of chaotic atrial tachycardia, left ventricular function returned to normal and therapy was stopped in both.

[Arrhythmogenic dysplasia of the right ventricle in a 16-month-old child]. / Dysplasie arythmogène du ventricule droit chez un enfant de 16 mois.

The clinical history of a 16-month old child with an arrhythmogenic right ventricular dysplasia is reported. This is one of the youngest patients described in the literature. The pitfalls of the diagnosis and the particularities of the treatment of recurrent ventricular tachycardias are underlined.

Complete atrioventricular dissociation and His bundle tachycardia in a newborn: problems in prenatal diagnosis and postnatal management.

A newborn infant with complete atrioventricular dissociation and infranodal tachycardia, detected at 33 weeks gestation by fetal echocardiography, is described. In the perinatal period, infra or juxta-nodal tachycardia was noted, compromising the hemodynamic state of the newborn. A combination of flecainide and propranolol terminated the arrhythmia.

[Therapy of fetal cardiac arrhythmia ante partum and sub partu]. / Therapie fetaler Herzrhythmusstörungen ante partum und sub partu.

After representation of importance and pathophysiology of fetal tachycardias a short review is given about principles and ways of the intrauterine cardioversion. They are the base for the following detailed description of the present therapeutical possibilities of fetal arrhythmias (sinustachycardia, paroxysmal supraventricular tachycardia and atrial flutter) under consideration of literature and own experience. Concluding recommendations about behaviour in case of fetal tachyarrhythmias are given.