胎儿缓慢性心律失常的临床表现及转归

Clinical manifestation and outcome of fetal bradyarrhythmia

目的 报道胎儿缓慢性心律失常的临床表现及转归。方法 搜集胎儿心动过缓孕妇的三通道胎儿心电图(FECG)检查资料,通过FECG特征对胎儿缓慢性心律失常进行分类,回顾分析病例资料包括孕妇免疫抗体、妊娠状态、胎儿首次出现缓慢性心律的时间,新生儿出生体重、转归情况及预后等。结果 34例胎儿发生缓慢性心律失常,其有3种类型:窦性心动过缓(窦缓组)10例(29.4%);房性早搏未下传二联律(房早未下传组)5例(14.7%);房室传导阻滞并交界性自主节律(房室阻滞组)19例(55.9%)。房室阻滞组胎儿首次出现缓慢性心律时周龄较其他两组更小(P<0.05),房早未下传组胎盘功能不良及脐带缠绕或扭转发生率明显高于其他两组(40%vs 10%、10.5%;P<0.05)。窦缓组胎儿心率于妊娠后期或出生后自行恢复正常,房早未下传组经药物治疗后转为窦性心律。房室阻滞组中,SSA/Ro-52阳性4例、ANA阳性2例,妊娠合并糖尿病1例,有心脏结构异常7例,新生儿心力衰竭2例;8例引产,2例宫内死亡,2例死产,2例于新生儿期死亡;其他两组胎儿无相关病例。结论 在胎儿缓慢性心律失常中,以交界性自主心律表现最多,其次为窦缓和房早未下传二联律;交界性自主节律的胎儿预后差,此与孕母免疫抗体阳性以及胎儿心脏结构异常有关。

Objective To report the clinical manifestation and outcome of fetal bradyarrhythmia. Methods The three channel fetal electrocardiogram(FECG) examination data of pregnant women with fetal bradycardia were collected, and the fetal bradyarrhythmia was classified according to the characteristics of FECG. The case data were analyzed retrospectively, including maternal immune antibody, pregnancy status, gestational age at first diagnosis, neonatal birth weight, outcome and prognosis. Results There were 3 types of bradyarrhythmia in 34 fetuses: sinus bradycardia(sinus bradycardia group) in 10 cases(29.4%);5 cases(14.7%) of blocked atrial bigeminy(group of blockedatrial bigeminy);19 patients(55.9%) had atrioventricular block(AVB) and junctional autonomic rhythm(group of AVB). The gestational age of the first occurrence of slow heart rhythm in the AVB group were younger than those in the other two groups(P<0.05), and The incidence of placental dysfunction and umbilical cord winding or twisting ingroup of blocked atrial bigeminy were significantly higher than that of the other two groups(40% vs 10%, 10.5%;P<0.05). In the sinus bradycardia group, the fetal heart rate returned to normal automatically in the late pregnancy or after birth, and turned to sinus rhythm after drug treatment in the group of blocked atrial bigeminy. In the AVB group, 4 cases were SSA/Ro-52 positive, 2 cases were ANA positive, 7 cases had structural heart disease, and 2 cases had neonatal heart failure;8 cases of labor induction, 2 cases of intrauterine death, 2 cases of stillbirth, and 2 cases of death in the neonatal period;There were no related cases in the other two groups. Conclusion Among fetal bradyarrhythmia, junctional spontaneous rhythm is the most common, followed by sinus bradycardia and blocked atrial bigeminy;The prognosis of fetuses with AVB and junctional autonomic rhythm is poor, which is related to the positive maternal immune antibody and abnormal fetal cardiac structure.[Chinese Journal of Cardiac Pacing and Electrophysiology,2022,36(6):519-522]