Rare Case of Fetal Permanent Junctional Reciprocating Tachycardia Refractory to Prenatal Antiarrhythmic Therapy
| Autor: | Frank Cetta, Jonathan N. Johnson, Philip L. Wackel, Carl H. Rose, Kavita Narang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
MFM maternal-fetal medicine Case Report 030204 cardiovascular system & hematology Amiodarone 03 medical and health sciences 0302 clinical medicine Internal medicine AVRT atrioventricular tachycardia medicine Sinus rhythm cardiovascular diseases 030212 general & internal medicine Flecainide NICU neonatal intensive care unit lcsh:R5-920 FHR fetal heart rate medicine.diagnostic_test business.industry AV atrioventricular Sotalol CS cesarean section medicine.disease Atrioventricular reentrant tachycardia SVT supraventricular tachycardia cardiovascular system Cardiology Supraventricular tachycardia PJRT permanent junctional reciprocating tachycardia lcsh:Medicine (General) business Fetal echocardiography Electrocardiography medicine.drug |
| Zdroj: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Vol 4, Iss 6, Pp 810-814 (2020) |
| ISSN: | 2542-4548 |
| DOI: | 10.1016/j.mayocpiqo.2020.07.002 |
| Popis: | Permanent junctional reciprocating tachycardia (PJRT) is a rare form of atrioventricular reentrant tachycardia that is commonly resistant to most antiarrhythmic medication therapy and over an extended duration can result in tachycardia-induced cardiomyopathy. The prenatal presentation of PJRT is typically similar to that of other types of fetal supraventricular tachycardia (SVT), making it difficult to distinguish from other forms of SVT in utero by fetal echocardiography. Surface electrocardiography after delivery is typically required to make a definitive diagnosis of PJRT. We report a case of fetal SVT at 19 weeks’ gestation refractory to maternal transplacental treatment with digoxin, amiodarone, flecainide, sotalol, metoprolol, intraumbilical amiodarone, and fetal intramuscular digoxin over the course of 12 weeks. Repeat cesarean delivery was performed at 30 2/7 weeks’ gestation for tachycardia-induced cardiomyopathy with hydrops fetalis. Postnatal electrocardiogram and continuous rhythm monitoring confirmed the diagnosis of PJRT. Combined neonatal treatment with amiodarone, digoxin, and propranolol was successful in reestablishment of sinus rhythm, with radiofrequency ablation planned if medical therapy eventually fails or once early childhood is reached. To our knowledge, this is the first described case of fetal PJRT refractory to multiple standard in utero antiarrhythmic modalities and highlights the importance of inclusion in the differential diagnosis. |
| Databáze: | OpenAIRE |
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