Fetal paroxysmal atrial fibrillation during transplacental therapy for supraventricular tachycardia Takekazu Miyoshi, MD, PhD, Heima Sakaguchi, MD, PhD,

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Presentation transcript:

Fetal paroxysmal atrial fibrillation during transplacental therapy for supraventricular tachycardia Takekazu Miyoshi, MD, PhD, Heima Sakaguchi, MD, PhD, Isao Shiraishi, MD, PhD, Jun Yoshimatsu, MD, PhD, Tomoaki Ikeda, MD, PhD HeartRhythm Case Reports Volume 5, Issue 1, Pages 22-24 (January 2019) DOI: 10.1016/j.hrcr.2018.10.004 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 Supraventricular tachyarrhythmia (SVT). Sustained SVT was confirmed by Doppler and M-mode recordings at 30 weeks of gestation. A: Doppler recording of superior vena cava (SVC)–ascending aorta (aAo) flow showed short ventriculoatrial (VA) tachycardia (VA/atrioventricular [AV] ratio = 0.44) with a ventricular rate of 215 beats per minute (bpm). B: M-mode recording using a 4-chamber view showed 1:1 AV conduction with a ventricular rate of 215 bpm. C: Fetal baseline heart rate varied between 210 and 220 bpm on cardiotocography. A indicates the retrograde A wave in the SVC corresponding to atrial contraction. V indicates the aortic ejection wave (V wave). LV = left ventricle; RA = right atrium. HeartRhythm Case Reports 2019 5, 22-24DOI: (10.1016/j.hrcr.2018.10.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Paroxysmal atrial fibrillation (PAF). PAF was confirmed by M-mode recording at 30 weeks of gestation. A: Doppler recording of superior vena cava (SVC)–ascending aorta (aAo) flow showed irregular bradycardia with a ventricular rate of 70–90 beats per minute (bpm). The A wave frequently disappeared. B: M-mode recording using a 4-chamber view also showed irregular bradycardia. Atrioventricular dissociation was present, with a ventricular rate of 70–90 bpm and an atrial rate of 40–50 bpm. After a clear atrial contraction, the unique quivering of the atrial wall (*) was observed, suggesting PAF. C: Fetal baseline heart rate intermittently fluctuated between 70 and 215 bpm on cardiotocography. LV = left ventricle; RA = right atrium. HeartRhythm Case Reports 2019 5, 22-24DOI: (10.1016/j.hrcr.2018.10.004) Copyright © 2018 Heart Rhythm Society Terms and Conditions