Key result
Left-sided accessory connections present in ~72% of infants with ORT and link to depressed ventricular function.
Why the study?
Is a left-sided accessory connection associated with adverse prenatal clinical course in infants with fetal tachycardia?
Observational (n=24)
No
Is a left-sided accessory connection associated with adverse prenatal clinical course in infants with fetal tachycardia?
A high proportion of infants with fetal tachycardia have left-sided accessory connections, which are associated with adverse fetal hemodynamics and the need for in utero antiarrhythmic therapy.
Left-sided accessory connections may flag fetal tachycardias needing in utero therapy; hypothesis-generating and requires prospective validation.
The most common mechanism of fetal tachycardia is orthodromic reciprocating tachycardia utilizing an accessory atrioventricular connection, however, data regarding accessory connection location in patients with fetal tachycardia is limited. To investigate the location of accessory connections in fetal tachycardia, postnatal transesophageal electrophysiology studies were performed at one institution over a 10-year period in 24 infants with documented fetal tachycardia. The 18 infants with inducible orthodromic reciprocating tachycardia were grouped according to accessory connection location, and groups were compared regarding prenatal presentation and clinical course. Left-sided connections were found in 13 (72%) patients, while accessory connection location could not be determined in the remaining 5 (28%) patients. The presence of a left-sided accessory connection was associated with sustained tachycardia, depressed ventricular function, and the need for antiarrhythmic therapy in utero. No other difference in clinical or electrophysiologic data was found between groups. Our findings indicate that a high proportion of patients with fetal tachycardia have left-sided accessory connections, and a left-sided connection may adversely affect fetal hemodynamics and cardiac output.
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Kannankeril et al. (2003) conducted an observational in Fetal tachycardia (n=24). Left-sided accessory connection vs. Undetermined accessory connection location was evaluated on Prenatal presentation and clinical course (sustained tachycardia, depressed ventricular function, need for antiarrhythmic therapy). Left-sided accessory connections were found in 72% of infants with inducible orthodromic reciprocating tachycardia and were associated with sustained tachycardia and depressed ventricular function.
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