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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2022, Vol. 18 ›› Issue (01): 15 -29. doi: 10.3877/cma.j.issn.1673-5250.2022.01.003

Standard·Proposal·Guideline

Expert guidance on prenatal treatment and management for fetal arrhythmia

Feta Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Perinatal Congenital Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society of Chinese Medial Association, Kaiyu Zhou1,1, Sun Chen2,2, Chuan Wang1,1, Yifei Li1,1, Wei Pan3,3, Bowen Zhao4,4, Yuqi Zhang5,5, Kunjing Pang6,6, Wenhong Ding7,7, Yunyun Ren8,8, Jianhua Lin9,9, Bo Han10,10, Haitao Lyu11,11, Qingyou Zhang12,12, Yurong Wu2,2, Baomin Liu13,13, Lin Wu14,14, Yanmin Zhang15,15, Tingting Xiao16,16, Yihua He17,17,†(), Yimin Hua1,1,†()   

  • Received:2021-06-11 Revised:2021-12-13 Published:2022-02-01
  • Corresponding author: Yihua He, Yimin Hua
  • Supported by:
    Key Research and Development Program of the Ministry of Science and Technology of China(2018YFC1002301, 2018YFC1002300); National Natural Science Foundation of China(82070324, 81800288); Key Research and Development Program of Science and Technology Department of Sichuan Province(2020YFS0101, 2019YJ0024, 2021YJ0211, 2021YFS0094)
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Fetal arrhythmias (FA) are common cardiac disorders in clinics of obstetrics and pediatric cardiology. Approximately 10% FA could persist or even progress, which may result in secondary organ injury, such as fetal heart failure, fetal premature delivery or even fetal demise. Based on accurate prenatal diagnosis of FA, reasonable classification and timely intervention for severely affected fetuses could improve prognosis of FA, which has great medical and sociological significance. Despite much progress have been achieved in field of prenatal management of FA in foreign countries, there are a few relevant studies in China. Moreover, there are great differences in prenatal management strategies for FA among different medical centers. In order to improve understanding of perinatal management of FA for obstetricians and pediatricians, standardize the intervention indications and treatment strategies, and promote the benign development of prenatal intervention for FA in China, experts from the Fetal and Perinatal Heart Disease Cooperation Team of Pediatric Cardiovascular Group of Chinese Pediatric Society, Chinese Medial Association put forward the Expert Guidance on Prenatal Treatment and Management for Fetal Arrhythmia after full discussion on prenatal intervention indications, treatment strategies as well as details of medicines selections according to the latest research progresses and current domestic situations. However, relevant clinical studies are limited to single-center, retrospective, and small sample size studies and the conclusions differed among different studies. Furthermore, only a minority of data were from China. Therefore, the evidences level are not so high. With further development of prenatal intervention for FA, the release of data from several multiple-centers, prospective and randomized controlled clinical studies, and with joint efforts of domestic clinicians, the content of this guidance will continue to be update and improved, and it will also be more in line with the actual domestic clinical practice needs, to achieve the goal of promoting continuous improvement of prenatal treatment and management of FA.

Key words: Arrhythmias, cardiac, Heart rate, fetal, Tachycardia, supraventricular, Atrial flutter, Atrioventricular block, Echocardiography, stress, Prenatal diagnosis, Hydrops fetalis, Practice management, medical, Fetus
图1 胎儿SVA干预流程图注：SVA为室上性心率失常，SVT为室上性心动过速，AF为心房扑动，FA为心率失常，FHR为胎心率，CVPS为心血管剖面评分，FH为胎儿水肿
图2 缓慢性FA干预流程图注：FA为胎儿心率失常，AVB为房室传导阻滞，FHR为胎儿心率，IVIG为静脉注射免疫球蛋白，EFE为心内膜弹力纤维增生症，DCM为扩张型心肌病
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