Atrial flutter in the perinatal age group: diagnosis, management and outcome.

OBJECTIVES: The aim of this retrospective study was to evaluate perinatal atrial flutter (AF) and the efficacy of maternally administered antiarrhythmic agents, postpartum management and outcome. BACKGROUND: Perinatal AF is a potentially lethal arrhythmia, and management of this disorder is difficult and controversial. METHODS: Forty-five patients with documented AF were studied retrospectively. RESULTS: Atrial flutter was diagnosed prenatally in 44 fetuses and immediately postnatally in 1 neonate. Fetal hydrops was seen in 20 patients; 17 received maternal therapy, 2 were delivered and 1 was not treated because it had a severe nontreatable cardiac malformation. In the nonhydropic group of 24 patients, 18 were treated and the remaining 6 were delivered immediately. In the hydropic group, 10 received single-drug therapy (digoxin or sotalol) and 7 received multidrug therapy. In the nonhydropic group, 13 received a single drug (digoxin or sotalol) and 5 received multiple drugs. One patient with rapid 1:1 atrioventricular conduction (heart rate 480 beats/min) died in utero and another died due to a combination of severe hydrops because of the AF, sotalol medication, stenosis of the venous duct and hypoplastic placenta. Of the 43 live-born infants, 12 were in AF at birth. Electrical cardioversion was successful in eight of nine patients. No recurrences in AF have occurred beyond the neonatal period. Four patients with fetal flutter and hydrops showed significant neurological pathology immediately after birth. CONCLUSIONS: Fetal AF is a serious and threatening rhythm disorder, particularly when it causes hydrops, it may be associated with fetal death or neurological damage. Treatment is required and primarily aimed at reaching an adequate ventricular rate and preferably conversion to sinus rhythm. Digoxin failed in prevention of recurrence at time of delivery in a quarter of our patients, whereas with sotalol no recurrence of AF has been reported, suggesting that class III agents may be the future therapy. Once fetuses with AF survive without neurological pathology, their future is good and prophylaxis beyond the neonatal period is unnecessary.

[Sub-valvular aortic stenosis by a discrete membrane]. / La sténose sous-valvulaire aortique d'origine membraneuse.

We report the case of a 55 year old patient presenting a discrete obstructive sub-aortic membrane. After clinical examination, complete echocardiographic evaluation and cardiac catheterisation, an operative procedure was decided and the sub-aortic membrane was resected. The results were satisfactory but the literature reports risks of re-obstruction of the left ventricular outflow tract. The article points out the importance of an early diagnosis and further stresses the major role played by transoesophageal echocardiography in the evaluation of the patient.

Atrial flutter in the human fetus: diagnosis, hemodynamic consequences, and therapy.

In the context of a large program of prenatal echocardiographic detection of fetal heart disease, special attention was paid to the in utero detection and identification of fetal heart rate disorders. This article focuses on 18 cases of tachycardiac fetuses. It provides information on how to identify the nature of the detected tachycardia, the hemodynamic consequences of tachycardia, the particular characteristics of fetal atrial flutter, and the efficacy of the transmaternal treatment of fetal tachycardia. It also describes an original way to grade and score the degree of fetal heart failure that proved useful for the assessment and monitoring of in utero therapeutic procedures. The results presented stress the efficacy of digoxin for fetal atrial flutter as well as the usefulness of prenatal echocardiography in the assessment of anatomical, functional, and rhythmic conditions of the fetal heart.