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To ensure a seamless transition from fetal to postnatal life of babies receiving a prenatal diagnosis of an arrhythmia.
This guideline is for neonatologists and paediatric cardiology teams, caring for babies with a prenatal diagnosis of a fetal arrhythmia.
Fetal arrhythmias are uncommon and the incidence of structural cardiac abnormalities in fetuses with irregular heart rhythms is low (<2%). Ectopic beats are estimated to be present in around 1% of unselected pregnancies and in the majority of cases will resolve before delivery.
Fetal tachycardia can result in significant morbidity and mortality if left untreated in utero. The ideal management is to treat the tachycardia prior to delivery so that the fetus is delivered in a non-hydropic state, at term, without evidence of tachycardia. Prenatal therapy is guided by the fetal cardiology and fetal medicine team jointly and in our institution 1st line maternal therapy is often flecainide. The addition of second line therapy is required in resistant cases. Therapy is carefully considered, implemented and monitored due to the potential adverse effects to the mother and fetus.
a) If extrasystoles persist after birth
b) If extra-systoles have resolved prior to birth
a) Failure to cardiovert medically during fetal life
b) Successful medical cardioversion during fetal life
Last reviewed: 03 May 2023
Next review: 31 May 2025
Author(s): Dr Lindsey Hunter; Dr Karen McLeod; Lorraine Mulholland; Kathleen O’Reilly; Dr Andrew MacLaren
Approved By: Paediatric Cardiology & Neonatology
Reviewer Name(s): A Powls; M Worrall; G Bell
Document Id: 1081