Contribution of Fetal Magnetocardiography to Diagnosis, Risk Assessment, and Treatment of Fetal Arrhythmia.
Contribution of Fetal Magnetocardiography to Diagnosis, Risk Assessment, and Treatment of Fetal Arrhythmia.
复制标题
胎儿心磁图对胎儿心律失常诊断、风险评估和治疗的作用。
DOI：
10.1161/jaha.121.025224
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发表时间：
2022-08-02
影响因子：
5.4
通讯作者：
Wakai, Ronald T.
中科院分区：
文献类型：
--
作者：
Wacker-Gussmann, Annette;Strasburger, Janette F.;Wakai, Ronald T.
关键词：
胎儿超声心动图一直是胎儿心律失常诊断的支柱;然而，胎儿心磁图（fMCG）最近已成为临床可用。我们试图确定fMCG在多大程度上有助于胎儿心律失常诊断和风险评估的精确度和准确性，以及这如何改变妊娠管理。我们回顾了在过去10年中，由于胎儿心律失常或心律失常风险，215例孕妇被转诊到UW麦迪逊生物磁学实验室的fMCG描记和医疗记录。我们使用评定量表比较了转诊诊断和治疗与fMCG诊断，并将我们的审查限制在心动过速、心动过缓/房室传导阻滞和家族性长QT综合征类别的144例受试者中。在117/144（81%）例患者中观察到了超声心动图或替代诊断以外的其他fMCG结果，其中81例（56%）为关键变化。8例（5.5%）患者在fMCG前心律失常消退。在109/144（76%）例胎仔中观察到至少中度的管理变化，其中35/144（24%）例为重大变化。最多样化的fMCG表现是长QT综合征，存在于所有3个转诊类别中。5例死胎中4例有长QT综合征。9例胎儿出现尖端扭转型室性心动过速，其中只有2例在fMCG前被识别。快速消费品对心律失常或家族性心律失常风险的产前诊断和管理具有重大影响，这是现有技术无法完全满足的。在未来，胎儿监护中心需要将fMCG和胎儿超声心动图结合起来，以优化护理。
Fetal echocardiography has been the mainstay of fetal arrhythmia diagnosis; however, fetal magnetocardiography (fMCG) has recently become clinically available. We sought to determine to what extent fMCG contributed to the precision and accuracy of fetal arrhythmia diagnosis and risk assessment, and in turn, how this altered pregnancy management. We reviewed fMCG tracings and medical records of 215 pregnancies referred to the Biomagnetism Laboratory, UW‐Madison, over the last 10 years, because of fetal arrhythmia or risk of arrhythmia. We compared referral diagnosis and treatment with fMCG diagnosis using a rating scale and restricted our review to the 144 subjects from the tachycardia, bradycardia/AV block, and familial long QT syndrome categories. Additional fMCG findings beyond those of the referring echocardiogram, or an alternative diagnosis were seen in 117/144 (81%), and 81 (56%) were critical changes. Eight (5.5%) had resolution of arrhythmia before fMCG. At least moderate changes in management were seen in 109/144 (76%) fetuses, of which 35/144 (24%) were major. The most diverse fMCG presentation was long QT syndrome, present in all 3 referral categories. Four of 5 stillbirths were seen with long QT syndrome. Nine fetuses showed torsades de pointes ventricular tachycardia, of which only 2 were recognized before fMCG. FMCG has a significant impact on prenatal diagnosis and management of arrhythmias or familial arrhythmia risk, which cannot be fully met by existing technology. The combination of fMCG and fetal echocardiography in fetal care centers will be needed in the future to optimize care.