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Created on : 20 Feb 2004
Modified on : 02 Dec 2007

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Bibliographical entry (without author) :

Arythmies foetales : diagnostic, pronostic, traitement ; à propos de 33 cas. Gynécologie Obstétrique & Fertilité 2000;28(10):729-37.

Author(s) :

Vautier-Rit S, Dufour P, Vaksmann G, Subtil D, Vaast P, Valat AS, Dubos JP, Puech P.

Year of publication :

2000

URL(s) :

http://www.sciencedirect.com/science?_ob=ArticleUR…

Résumé (français)  :

D’octobre 1993 à février 1998, 33 troubles du rythme cardiaque foetal ont été explorés par l’équipe de cardiologie infantile et congénitale de Lille. Les extrasystoles sont de loin les arythmies les plus fréquemment retrouvées (76 % des cas). Elles sont constamment bénignes et ne nécessitent qu’une simple surveillance. Les tachycardies sont retrouvées dans 15 % des cas (trois tachycardies supraventriculaires et deux flutters auriculaires). De nombreux traitements efficaces sont proposés, cependant le pronostic reste souvent sombre en présence d’une anasarque. Les techniques de traitement foetal direct (cordocentèse) sont en cours d’évaluation et ne peuvent être actuellement utilisées qu’en dernier recours (un décès après injection de Flécaïne® intracordonale dans notre série). Une bradycardie (non liée à des extrasystoles) est retrouvée dans 9 % des cas. Il n’existe pas actuellement de traitement efficace démontré in utero.

Abstract (English)  :

From October 1993 to February 1998, 33 cases of fetal cardiac arrhythmia were investigated by doppler-echocardiography at the Lille infantile and congenital cardiology department. Extrasystolic arrhythmias were the most frequently encountered disorder (25 fetuses, i.e., 76% of cases: 24 instances of extrasystolic auricular arrhythmia and one case of extrasystolic ventricular arrhythmia). They were invariably benign, and apart from one case only required standard monitoring. Tachycardia was observed in 15% of cases (three cases of supraventricular tachycardia [SVT] and two cases of auricular flutter [AF]). In no instance was a cardiopathic syndrome noted. A number of efficient treatments have been described, but the prognosis is often poor in the presence of hydrops fetalis. Direct fetal treatments (cordocentesis) are currently under evaluation, and at present can only be used as a last resort. In our series, one fetus died 15 minutes after transplacental Flecaine® (flecainide) administration. Two of the three SVT and the two AF cases were successfully treated. Bradycardia, which was unassociated with extrasystolic arrhythmia, was found in 9% of cases. It is concluded that Flecaine® is probably the treatment of choice for supraventricular and ventricular fetal tachycardia, as it has no teratogenic effect and crosses the placenta at a fetal concentration that is 80% of the maternal level. However, the administration of this drug is not without risk. It is known to possess certain negative side effects, and its pharmacological profile and maternal and fetal health risks have not yet been fully investigated. At present, no entirely safe and efficient treatment for fetal cardiac arrhythmia has been found.

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Keywords :

➡ fetal distress ; monitoring

Author of this record :

Cécile Loup — 20 Feb 2004