Successful Management of Fetal Torsades de Pointes and Long QT Syndrome by a Cardio-Obstetrical Team

Figures

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  Figure 1. Spectral Doppler of Fetal Arrhythmias in This Case Simultaneous aortic outflow (above baseline) and superior vena cava (below baseline, V) during ventricular tachycardia (1.1) and second-degree AV block (1.2). Atrial events (A) are shown as retrograde flow during atrial contraction and are above baseline. (A) A regular A-A interval with atrioventricular (AV) dissociation. After the fourth A, a 3-beat run of ventricular tachycardia (V4-V6) occurs with a faster V than A rate. The second to last A beat is conducted to V7, and the last A is blocked. (B) Mobitz 1, second-degree AV block with 3:2 conduction. The A-A interval is consistent, but the AV interval prolongs. The first A is not conducted, the second A is conducted with a normal AV interval and the third A is conducted with a prolonged AV interval. This pattern is then repeated.

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  Figure 2. M-Mode Ventricular tachycardia at a ventricular rate of 250 beats/min and simultaneous atrial rate of 140 beats/min (along with Video 1).

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  Figure 3. Fetal and Maternal Cardiovascular Responses to Medications BP = blood pressure; HR = heart rate.

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  Figure 4. 12-Lead Electrocardiogram at 10 Days of Age 12-lead electrocardiogram 10 days after birth showing intermittent accelerated idioventricular rhythm with a left bundle branch morphology and a normal QRS axis. The QTc remains prolonged (546 ms).