Fetal Bradyarrhythmias:Etiopathogenesis,Diagnosis and Treatment:Between Literature Review and Experience of a Tertiary Center

Fetal arrhythmias reach up around 10%of the total third-level perinatal cardiology references.Sustained bradycardia is defined as a baseline fetal heart rate(FHR)of less than 110 bpm sustained for at least 10 min.The overall incidence of malignant fetal bradyarrhythmias,such as complete atrioventricular block(AVB)and channellopathies,is relatively rare,1:5000 pregnancies,but represents a serious emergency for the gynecologist,neonatologists,and pediatric cardiologists.Fetal complete AVB is strongly associated with maternal connective tissue disease,but it can be also associated with congenital heart disease and usually with a poorer prognosis with high risk of fetal hydrops and abortion.Currently,the treatment of severe fetal bradyarrhythmias is principally pharmacological and aims to increase the FHR,besides an early resolution of underlying causes,when possible,and a promptly management of fetal heart failure.Intrauterine electrostimulation nowadays is an experimental pioneering method,reserved for limited selected cases.

Life Threatening Broad QRS Tachycardia in an Infant with Conduction Disorder and SCN5A Mutation

We present the case of an infant admitted to our department for a rapid broad complex tachycardia and cardiovascular collapse.The patient was submitted to genetic testing because of a conduction defect at baseline ECG and family history of gene mutation.A new SCN5A gene mutation variant was found leading to diagnosis of sodium-channel dysfunction arrhythmia.

Arrhythmias in Common Arterial Trunk(CAT):Uncommon Atrial Tachycardia in CAT with Anomalous Pulmonary Venous Connection and Re-entry Atrial Tachycardia in CAT with HIV Seropositive Mother

We show a brief report of two common arterial trunk cases(CAT)with different arrhythmias and discuss anatomy,clinical and diagnostic management.The burden of volume and pressure overload of this cardiac malformation may predispose to different types of arrhythmia before and after surgical repair.Because of labile hemodynamic state in this group of patients,prompt diagnosis of any arrhythmia is mandatory as the devastating factor on prognosis.The first patient with a diagnosis of CAT Type II Collett and Edwards(CE)had a particular history with HIV seropositive mother assuming antiretroviral therapy during pregnancy,who presented hyperbilirubinemia and liver dysfunction at birth,and re-entry atrial tachycardia after repair.The second patient had CAT Type I CE with a partial anomalous venous connection of left superior pulmonary vein and uncommon type of atrial tachycardia with dual AV nodal physiology.

Management of“Wall to Wall Heart”in a Transient Neonatal Tricuspid Regurgitation

We present a case of a one-day-old newborn,without prenatal diagnosis,referred to our cardiologic intensive care unit in critical condition presenting sub-cyanosis and peripheral oxygen saturation of 80%.Echocardiography diagnosis was tricuspid valve dysplasia with severe regurgitation,functional pulmonary valve atresia with intact ventricular septum and reversal flow in the large patent ductus arteriosus(PDA).Chest X-ray showed severe cardiomegaly and wall to wall heart.Prostaglandin E1 infusion was started once after birth.After few days,clinical conditions progressively worsened because of right heart failure;a first pharmacological approach to close PDA failed and surgery ligation of PDA was necessary to restore anterograde pulmonary flow and heart size.

Epicardial Versus Endocardial Pacemakers in the Pediatric Population:A Comparative Inquiry

Background:Most children in need of cardiac pacemakers remain dependent on the function of the permanent from childhood to adulthood.We sought to evaluate and compare the function between epicardial and endocardial pacemakers in pediatric groups with different conditions.Methods:Between 2012 and 2018,this single-canter study evaluated 44 pediatric patients with indications for epicardial or endocardial pacemakers.Results:The 2 groups,at a median age of 5(0.1–16)years,were compared concerning the characteristics of the leads used(n=80:bipolar,unipolar,steroid-eluting,and non–steroid-eluting),survival data,and complications.The reason for pacemaker implantation was congenital complete heart block in 11(25%)cases and postoperative heart block in 33(75%)cases.The commonest congenital heart disease accompanied by postoperative block was the ventricular septal defect.In the endocardial lead group,the mean ventricular pacing threshold immediately after the implantation and during the follow-up was less than that in the epicardial lead group(0.75 vs.0.81 V;P=0.01 and 0.8 vs.2.4 V;P=0.001).During the follow-up,the mean battery longevity was better in the endocardial group(last visit:6.7 endocardial vs.3.3 years epicardial).Lead failure was commoner in the epicardial pacemaker,and chronic high-pacing threshold pattern was seen in 14 patients in this group.After 3 years,freedom from lead failure was 94%and 63%in the endocardial and epicardial leads.Conclusions:Pacemakers with endocardial bipolar steroid-eluting leads showed better lead characteristics regarding survival and battery longevity than epicardial pacemakers without these lead characteristics.An appropriate pacemaker type should be selected based on the patient’s condition.