Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia
Magnetocardiographic rhythm patterns at initiation and termination of fetal supraventricular tachycardia
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DOI：
10.1161/01.cir.0000043801.92580.79
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发表时间：
2003-01-21
期刊：
影响因子：
37.8
通讯作者：
Gotteiner, NL
中科院分区：
文献类型：
--
作者：
Wakai, RT;Strasburger, JF;Gotteiner, NL
背景-使用胎儿心磁图（fMCG），我们首次描述了折返性胎儿室上性心动过速（SVT）的起始和终止的电生理模式，SVT是最常见的危及生命的胎儿心律失常形式。方法和结果-与折返性SVT由自发性房性早搏（PAC）起始并由自发性阻滞终止的预期相反，记录了5种不同的起始模式和4种终止模式，最常见的起始模式涉及折返性PAC。评估波形形态和时间，包括QRS和室房间期。这使得能够检测到诸如沃尔夫-帕金森-白色综合征、QRS异常和多个折返通路等现象，这些现象对于定义节律模式至关重要。此外，fMCG心动描记图显示胎儿躯干运动和SVT的启动和终止之间的联系出乎意料的强，这表明自主神经的影响发挥了关键作用。结论-这项研究表明，胎儿SVT的启动和终止的模式比通常认为的更多样化，最常见的启动模式涉及折返性PAC。辨别这种模式的能力可以帮助阐明潜在的机制和指导抗肿瘤药物治疗。fMCG提供了一种分析子宫内复杂快速性心律失常的非侵入性方法，其功效接近出生后心电图节律监测。
Background-Using fetal magnetocardiography (fMCG), we characterize for the first time the electrophysiological patterns of initiation and termination of reentrant fetal supraventricular tachycardia (SVT), the most common form of life-threatening fetal arrhythmia.Methods and Results-In contrast to the expectation that reentrant SVT is initiated by spontaneous premature atrial contractions (PACs) and is terminated by spontaneous block, 5 distinct patterns of initiation and 4 patterns of termination were documented, with the most common patterns of initiation involving reentrant PACs. Waveform morphology and timing, including QRS and ventriculoatrial interval, were assessed. This enabled detection of such phenomena as Wolff-Parkinson-White syndrome, QRS aberrancy, and multiple reentrant pathways that were crucial for defining the rhythm patterns. In addition, fMCG actocardiography revealed an unexpectedly strong association between fetal trunk movement and the initiation and termination of SVT, suggesting that autonomic influences play a key role.Conclusions-This study demonstrates that the patterns of initiation and termination of fetal SVT are more diverse than is generally believed and that the most common patterns of initiation involve reentrant PACs. The ability to discern such patterns can help elucidate the underlying mechanisms and guide antiarrhythmic drug therapy. fMCG provides a noninvasive means of analyzing complex tachyarrhythmia in, utero, with efficacy approaching that of postnatal electrocardiographic rhythm monitoring.