Fetal atrial flutter: Diagnosis, clinical features, treatment, and outcome☆,☆☆,★
Section snippets
Definitions
Intrauterine atrial flutter was defined as a rapid regular atrial rate of 300 to 600 beats/min and a 1:1 atrioventricular conduction, or a variable degree of AV block, resulting in an identical or slower ventricular heart rate. The highest ventricular rate (peak heart rate) was used as an indicator of the severity of fetal tachycardia. Atrial flutter was considered incessant when observed permanently or when present more than 50% of the time during the echocardiographic examination
Clinical Presentation
Atrial flutter was detected in 10 male and 5 female fetuses at a mean gestational age of 34 ± 4 weeks (Table I).
Case, Sex GA at detection Atrial rate (bpm) Peak HR (bpm) Degree of AV block Pattern Signs of CHF Tx in utero GA at birth Tx after birth Recurrence of AFl Neonatal ECG Heart disease 1, M 37 360 180 2:1 Sustained No D(-) 40 No No Normal No 2, F 35 460 230 2-3:1 Sustained No D(+) 39 D No Normal No 3, M 34 300 150 2:1 Intermittent No D(+) 38 No No Normal No 4, F 38 378 189 2:1
Incidence and Clinical Presentation of Fetal Atrial Flutter
After a review of the literature, only 37 echocardiographically documented cases of fetal atrial flutter could be found (Table II).
Author Patients Mean GA Mean atrial rate Maximal heart rate CHF Prenatal conversion Postnatal conversion Relapse of AFl after birth Malformation/ death Kleinman et al.8(1983) 1 38 360 180 1 0 1 0 No 1 34 nm Bradycardia 1 0 Stillbirth Hirata et al.7(1985) 1 34 460 230 1 1 0 No Vintzileos et al.9(1985) 1 33 416 208 1 0 1 CHF, prematurity, death
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Cited by (109)
Arrhythmias in children: Too fast or too slow
2022, Progress in Pediatric CardiologyFetal Tachycardia
2022, Maternal Cardiac Care: A Guide to Managing Pregnant Women with Heart DiseaseAntenatal Therapy for Fetal Supraventricular Tachyarrhythmias: Multicenter Trial
2019, Journal of the American College of CardiologySuccessful treatment of atrial flutter by repeated intraperitoneal and intra-amniotic injections of amiodarone in a fetus with hydrops
2016, Taiwanese Journal of Obstetrics and GynecologyCitation Excerpt :The reported incidence of fetal tachycardia is 0.3 cases per 1000 births [1], whereas fetal atrial flutter (AF) accounts for approximately one-third of fetal tachyarrhythmia [2].
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From the Fetal Cardiology Unit, Division of Pediatric Cardiology, Sainte-Justine Hospital, University of Montreal School of Medicine, Montreal, Quebec, Canada.
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Reprint requests: Jean-Claude Fouron, MD, Division of Pediatric Cardiology, Sainte-Justine Hospital, 3175, Ch. Côte Ste-Catherine, Montreal, Quebec, Canada, H3T 1C5.
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0022-3476/98/$5.00 + 0 9/21/83223