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Cardiac Arrhythmias in the Human Fetus

机译：胎儿的心律失常

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Fetal cardiac arrhythmias have been recognized with increasing frequency during the past several years. Most fetal arrythmias are intermittent extrasystoles, often presenting as irregular pauses of rhythm. These are significant only when they occur with appropriate timing to initiate sustained tachycardia, mediated by anatomic bypass pathways. The most common important fetal arrhythmias are: 1) supraventricular tachycardias, and 2) severe bradyarrhythmias, associated with complete heart block. Symptomatic fetal tachycardias are usually supraventricular in origin, and may be associated with the developmet of hydrops fetalis. These patients may respond to antiarrhythmic drug therapy, administered via maternal ingestion or via direct fetal injection. Such therapy should be offered with careful fetal and maternal monitoring, and must be based on a logical, sequential analysis of the electrical mechanism underlying the arrhythmia, and an appreciation of the pharmacology and pharmacokinetics of the maternal, placental fetal system. Bradycardia from complete heart block may either be associated with complex congential heart malformations involving the atrioventricular junction of the heart, or may present in fetuses with normal cardiac structure, in mothers with autoimmune conditions associated with high titres of anti-SS-A or anti-SS-B antibody, which cross the placenta to cause immune-related inflammatory damage to the fetal atroventricular node. This paper reviews experience with the analysis of fetal caridac rhythm, a detailed discussion of the pathophysiology of arrhythmias and their effect on the fetal circulatory system, and offers a logical framework for the construction of treatment algorithms for fetuses at risk for circulatory compromise from fetal arrhythmias.
机译：在过去的几年中，人们已经认识到胎儿心律失常的频率越来越高。大多数胎儿心律失常是间歇性的心脏收缩，通常表现为不规则的节律性停顿。仅当它们在适当的时机发生以引发持续的心动过速（由解剖旁路途径介导）时，这些才有意义。最常见的重要胎儿心律失常是：1）室上性心动过速，和2）严重的心律失常，伴有完全的心脏传导阻滞。有症状的胎儿心动过速通常起源于室上，并可能与胎儿积水的发展有关。这些患者可能会对通过孕妇摄入或直接胎儿注射进行的抗心律不齐药物治疗产生反应。此类治疗应在胎儿和产妇进行仔细监测的情况下进行，并且必须基于对心律不齐的电气机制进行逻辑，顺序的分析，并对产妇，胎盘胎儿系统的药理学和药代动力学有所了解。患有完全性心脏阻滞的心动过缓可能与复杂的连续性心脏畸形有关，涉及心脏的房室交界，或者可能存在于具有正常心脏结构的胎儿中，其母亲患有自身免疫性疾病，伴有高滴度的抗SS-A或抗SS-B抗体穿过胎盘对胎儿的房室结造成免疫相关的炎性损害。本文回顾了胎儿心律失常的分析经验，详细讨论了心律失常的病理生理学及其对胎儿循环系统的影响，并为构建有可能因胎儿心律不齐而遭受循环损害的胎儿的治疗算法提供了逻辑框架。

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