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Mortality rates equal for atrial flutter, tachycardia. (Fetal Polyarrhythmia).

NEW YORK -- Fetal atrial flutter gets diagnosed about 2 weeks later in pregnancy than does fetal supraventricular tachycardia, but mortality rates are similar in fetuses with either polyarrhythmia, according to results of a metaanalysis.

The medical literature in general suggests that among fetuses with cardiac polyarrhythmias 20%-33% will have atrial flutter, and 60%-70% will have supraventricular tachycardia.

Some authors have suggested that prognosis is worse with atrial flutter than with supraventricular tachycardia, Dr. Martin Krapp commented at the 12th World Congress on Ultrasound in Obstetrics and Gynecology.

To better counsel parents in these cases, Dr. Krapp and his associates at the University of Lubeck (Germany) conducted a metaanalysis of 10 studies published since 1990. Of the 485 fetuses diagnosed with cardiac polyarrhythmias, 26% had atrial flutter, 73% has supraventricular tachycardia, and the rest had ventricular tachycardia or other problems.

Physicians diagnosed supraventricular tachycardia at 28-33 weeks' gestation and atrial flutter at 31-34 weeks. Rates of hydrops fetalis did not differ significantly between groups--39% of the atrial flutter group and 41% of the supraventricular tachycardia group.

Among fetuses with atrial flutter, the median atrial rate of 450 beats per minute did not differ between fetuses with or without hydrops, but hydropic fetuses had a higher median ventricular rate, compared with nonhydropic fetuses: 240 vs. 220 beats per minute, Dr. Krapp said.

Digoxin--the first choice in treatment for a majority of fetuses in both the atrial flutter and supraventricular tachycardia groups-has succeeded in converting more nonhydropic fetuses than hydropic ones.

First-line treatment for hydropic fetuses with polyarrhythmias probably should combine a second drug with digoxin to improve chances of success in that group, he said.

Overall mortality rates were 8% in the atrial flutter group and 9% in the supraventricular tachycardia group, he reported at the meeting, sponsored by the International Society of Ultrasound in Obstetrics and Gynecology.
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Author:Boschert, Sherry
Publication:OB GYN News
Date:Feb 1, 2003
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