目的:评估先天性胎儿缓慢性心律失常的病因,特点,危险因素,和预后。
方法:这项回顾性研究涉及患有胎儿缓慢性心律失常的胎儿。所有胎儿均采用超声检查。获得了父母的心电图和家族史,和母体自身抗体进行测量。诊断时的妊娠年龄,胎儿心房和心室率,缓慢性心律失常的类型,是否存在先天性心脏病(CHD),胎儿水肿,胎儿心肌功能障碍,心脏外异常,母体自身免疫性疾病,母体自身抗体以及产前治疗,并收集新生儿结局。
结果:在纳入研究的40个胎儿中,11人患有母亲风湿病,16例患有复杂的心脏异常,例如左右异构现象。患有冠心病的胎儿与没有冠心病的胎儿明显不同,心脏外异常的发生率增加,积水,28天后胎儿死亡和存活时间缩短(p<0.05)。患有母亲风湿性疾病的胎儿的生存率明显优于没有母亲风湿性疾病的胎儿(p<0.05)。对11例胎儿进行了母亲抗心律失常治疗。在子宫内,母体治疗在有或没有母体风湿病的胎儿中,心律失常或水肿的过程没有显着差异(p<0.05)。在回归分析中,无胎儿水肿是与生存相关的唯一独立因素(p=0.04).
结论:缓慢性心律失常的病程,伴随着生存,似乎在患有母亲风湿性疾病的胎儿中比在患有CHD的胎儿中更有利,尤其是左右异构。水肿是与生存不良相关的唯一独立因素。
OBJECTIVE: To assess congenital fetal bradyarrhythmias with regard to etiological causes, features, risk factors, and prognosis.
METHODS: This retrospective study involved fetuses with fetal bradyarrhythmias. All fetuses were evaluated by ultrasonography. Parental ECGs and family histories were obtained, and maternal autoantibodies were measured. Gestational age at diagnosis, fetal atrial and ventricular rates at presentation, type of bradyarrhythmias, the presence or absence of a congenital heart defect (CHD), fetal hydrops, fetal myocardial dysfunction, extra-cardiac abnormalities, maternal autoimmune diseases, maternal autoantibodies as well as prenatal treatment, and neonatal outcome were collected.
RESULTS: Of the 40 fetuses included in the study, 11 had maternal rheumatologic disease, 16 had complex cardiac anomalies such as left and right isomerism. Fetuses with CHD significantly differed from those without CHD with increased rates of extra-cardiac anomalies, hydrops, fetal deaths and shorter survival after 28 days (p<0.05). Survival was significantly better in fetuses with maternal rheumatic disease as compared with those with no maternal rheumatic disease (p<0.05). Maternal anti-arrhythmic therapy was administered in 11 fetuses. In utero maternal treatment resulted in no significant difference in the course of arrhythmia or hydrops in fetuses with or without maternal rheumatic disease (p<0.05). In regression analysis, the absence of fetal hydrops was the only independent factor associated with survival (p=0.04).
CONCLUSIONS: The course of bradyarrhythmias, along with survival, seems to be more favorable in fetuses with maternal rheumatic disease than in those with CHD, especially left and right isomerism. Hydrops was the sole independent factor associated with poor survival.