Fetal cardiac arrhythmias: Doppler assessment

Pregnancies in which fetal cardiac arrhythmias are present are associated with an elevated perinatal and neonatal mortality. In this group various major and minor fetal malformations, including heart malformations, are more common. FECG and phonocardiogram give some information on the type of arrhythmia in favorable cases. Real-time imaging detects fetal heart malformations and late signs of heart failure. Fetal echocardiogram is of great aid for the classification of the arrhythmia and for the detection of heart malformations. By applying combined real-time linear array and pulsed Doppler technique in cases of fetal cardiac arrhythmia, important information on the fetal circulatory state can be obtained. Estimations of the volume blood flow guide the clinician in the practical handling of these cases. Volume blood-flow estimations can probably detect imminent fetal heart failure. Therapeutic effects can be followed, and the timing of delivery can be optimized taking the circulatory state into account. Within the fetal heart rate range 50 to 250 beats/min adequate blood circulation is usually maintained in the fetus. The peak velocity, the acceleration, and the rising slope are all increased in the postextrasystolic beat, indicating the existence of postextrasystolic potentiation in the fetal heart. These three parameters can be related to the ventricular filling time, supporting the opinion that the fetal heart follows the rules of the Frank Starling relationship. Fetal arrhythmias constitute also an experimental model for the study of fetal cardiac physiology.