Author + information
- Silvia Alvarez,
- Paul Brooks,
- Nee Scze Khoo,
- Timothy Colen and
- Lisa Hornberger
Background: Accurate fetal arrhythmia diagnosis is key for effective management. Traditional echo-based techniques used in fetal arrhythmia (FA) assessment (M mode and PW Doppler) require adequate fetal position and cursor alignment to define temporal relationships between atrial (A) and ventricular (V) events. Whether color tissue Doppler imaging (TDI) facilitates FA diagnosis and is of added value to standard techniques has not been fully explored.
Methods: We prospectively recruited 34 pregnant women diagnosed with FA to undergo color TDI following fetal echo assessment. Multiple beat TDI clips of the 4-chamber in any orientation were recorded (Frame rate ≥ 180fps). Observer was blinded to outcome. Sample-volumes were placed on atrial and ventricular wall to display simultaneous trace of A and V activity. Timing of cardiac cycle events were supplemented by frame-by-frame analysis of the 2D image, including AV valve closure. Intervals A-A, V-V, A-V and V-A were measured with high temporal resolution from the color TDI dataset tracing.
Results: Thirty-two of 34 pregnancies with FA were captured on TDI with most diagnosis made within 5 minutes of analysis. FA include: 17 tachycardias (2 atrial flutter, 10 ectopic atrial tachycardia, 3 AV re-entry tachycardia, 2 ventricular tachycardia); 6 bradycardias (3 complete AV block (AVB), 2-1° AVB including 1 evolving to 2° and 3° AVB, 1 sinus bradycardia); 9 with ectopic beats (7 atrial, 2 ventricular). All FA diagnosis by TDI concurred with the primary diagnosis by standard techniques. Thirteen (40%) FA had additional findings on TDI, including demonstrating 2° AVB instead of atrial bigeminy with block, more than one type of ectopy and intermittent V-A conduction in ventricular tachycardia. TDI was most helpful in supraventricular tachycardia with consistent evaluation of A-V and V-A intervals and the changing relationship of A and V rates facilitating mechanism assessment in 7 (47%) in whom standard techniques could not.
Conclusions: Color TDI with offline analysis permits rapid and accurate definition of FA mechanism and provides new information in a substantial proportion (40%) of affected pregnancies.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Heart Disease: New Diagnostic Approaches in Congenital Heart Disease
Abstract Category: 10. Congenital Heart Disease: Pediatric
Presentation Number: 1231-014
- 2017 American College of Cardiology Foundation