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首页> 外文期刊>Circulation journal >Evaluation of transplacental treatment for fetal congenital bradyarrhythmia-nationwide survey in Japan
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Evaluation of transplacental treatment for fetal congenital bradyarrhythmia-nationwide survey in Japan

机译：日本经胎盘治疗胎儿先天性心律失常的评估

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Background: There are few large studies of fetal congenital bradyarrhythmia. The aim of the present study was to investigate the effects and risks of transplacental treatment for this condition. Methods and Results: Using questionnaires, 128 cases of fetal bradyarrhythmia were identified at 52 Japanese institutions from 2002 to 2008. Of the 128 fetuses, 90 had structurally normal hearts. Among these 90 fetuses, 61 had complete atrioventricular block (CAVB), 16 had second-degree AVB, 8 had sinus bradycardia, and 5 had other conditions. The 61 CAVB fetuses were divided into those who did (n=38) and those who did not (n=23) receive transplacental medication. Monotherapy with β-sympathomimetics, steroid monotherapy, and combination therapy with these agents was given in 11, 5 and 22 cases, respectively. Beta-sympathomimetics improved bradycardia (P<0.001), but no medication could significantly improve the survival rate. Fetal hydrops was associated with a 14-fold increased risk of perinatal death (P=0.001), and myocardial dysfunction was a significant risk factor for poor prognosis (P=0.034). Many adverse effects were observed with steroid treatment, with fetal growth restriction increasing significantly after >10 weeks on steroids (P=0.043). Conclusions: Treatment with β-sympathomimetics improved bradycardia, but survival rate did not differ significantly in fetuses with and without transplacental medication. It is recommended that steroid use should be limited to <10 weeks to avoid maternal and fetal adverse effects, especially fetal growth restriction and oligohydramnios.
机译：背景：关于胎儿先天性心律失常的大型研究很少。本研究的目的是调查经胎盘治疗这种情况的效果和风险。方法和结果：使用问卷调查，从2002年至2008年在日本的52家机构中鉴定出128例胎儿心律失常。在128例胎儿中，有90例心脏结构正常。在这90例胎儿中，有61例具有完全的房室传导阻滞（CAVB），有16例具有二级AVB，有8例患有窦性心动过缓，还有5例患有其他疾病。将61例CAVB胎儿分为经胎盘药物治疗者（n = 38）和不接受胎盘动物（n = 23）。分别在11例，5例和22例中进行了β-拟交感神经药的单药治疗，类固醇单药治疗以及这些药物的联合治疗。 β-拟交感神经药可改善心动过缓（P <0.001），但没有药物可显着提高生存率。胎儿积液与围产期死亡风险增加14倍相关（P = 0.001），而心肌功能障碍是预后不良的重要危险因素（P = 0.034）。用类固醇治疗观察到许多不良反应，在类固醇治疗超过10周后，胎儿生长受限明显增加（P = 0.043）。结论：β-拟交感神经药治疗改善了心动过缓，但在有无胎盘药物治疗的胎儿中，存活率没有显着差异。建议将类固醇的使用限制在10周以内，以避免对母婴造成不利影响，尤其是限制胎儿生长和羊水过少。

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