Challenge of managing opposing rhythms in a mother and fetus.

INTRODUCTION: We report a case of a fetus with complex congenital heart disease and supraventricular tachycardia in the setting of maternal high grade atrioventricular block at 26 weeks' gestation. METHODS AND RESULTS: Electroanatomic mapping allowed successful implantation of a permanent pacemaker to provide adequate back-up pacing in the mother with zero radiation exposure, thus allowing safe delivery of transplacental anti-arrhythmic medications to reduce the fetal arrhythmia burden and optimize the fetal ventricular rate. CONCLUSION: This is the first reported case of using electroanatomic mapping, with zero fluoroscopy use, for pacemaker lead placement and for a novel indication.

Avoiding physician burnout through physical, emotional, and spiritual energy.

PURPOSE OF REVIEW: The purpose of this review is to update the physician community on current evidence regarding ways individuals can combat the rise in physician burnout. More than half of US physicians are experiencing at least some degree of burnout and the incidence has increased significantly over the past decade. RECENT FINDINGS: Recent findings suggest practicing physical, mental, and emotional self-care are important factors in avoiding physician burnout. Current evidence demonstrates that physical exercise can improve mood, enhance one's ability to deal with stress, and promote high-quality sleep. New research in the field of nutritional psychiatry supports the association between diet and mental health. A recent study found that the risk of depression is lower in people who eat a diet high in fruits, vegetables, unprocessed grains, and low amounts of animal and dairy products. In addition, there is a growing body of evidence that practicing mindfulness meditation can help reduce the symptoms of physician burnout by reducing stress and improving physical and emotional well-being. SUMMARY: The implications of decreasing physician burnout are improved patient safety, job retention, monetary savings, and better patient care.

Utility of fetal echocardiography in postnatal management of infants with prenatally diagnosed congenital heart disease.

OBJECTIVE: Congenital heart disease (CHD) remains a significant cause of neonatal morbidity and mortality. This study evaluates the success of fetal echocardiography (FECHO) in guiding delivery management in pregnancies complicated by CHD. METHODS: Cases with CHD diagnosed by prenatal FECHO performed at a single institution from January 2000 to June 2005 were retrospectively reviewed. The accuracy of prenatal diagnosis and the appropriateness of proposed care plans based on FECHO were compared to postnatal care plans based on neonatal echocardiograms (NECHOs). RESULTS: Of the 72 mother-infant pairs with prenatally diagnosed CHD, 53 underwent NECHO. Overall, the FECHO diagnosis matched the NECHO diagnosis in 50 out of 53 cases (94.3%). The NECHO added diagnostic or functional information in 6 of the 53 FECHO cases. Three of these were minor and would not have resulted in a significant change of delivery plans. The other three were major findings and would have resulted in a revision of delivery planning. Overall, 96% of the delivery plans based on FECHO agreed with the delivery plans based on NECHO. CONCLUSION: Fetal echocardiography has a high correlation with postnatal and neonatal echocardiographic findings. Delivery management plans may be based on fetal echocardiogram diagnoses.