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Importance of Close Follow-Up in the Fetus with Premature Atrial Contractions Accompanied by Atrial Septal Aneurysm: A Case Report

DOI: 10.1155/2013/391085

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Abstract:

Rhythms that derive from parts of atria other than the sinus node are called premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs. To the best of our knowledge, coexistence of tachycardia and bradycardia leading to hemodynamic impairment has not yet been reported. We present a fetus diagnosed with PACs and atrial septal aneurysm (ASA) on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. We suggest closer follow-up of fetuses with PACs accompanied by ASA. 1. Introduction Rhythms originating from atrial regions other than the sinus node are defined as premature atrial contractions (PACs). Vast majority of fetal PACs are idiopathic. Fetal PACs usually have a good prognosis and disappear spontaneously during pregnancy or after delivery [1]. PACs may rarely develop secondarily to underlying structural abnormalities. Presence of an atrial septal aneurysm (ASA) is the most commonly reported structural anomaly in fetuses [2, 3]. Development of fetal tachycardia or fetal bradycardia is rarely reported during follow-up of fetuses diagnosed with PACs [2–4]. To the best of our knowledge, coexistence of fetal tachycardia and bradycardia leading to hemodynamic impairment in the same fetus possibly due to coexisting PAC and ASA has not yet been reported. We present a fetus diagnosed with PACs and ASA on the 23rd week of gestation proceeding to fetal bradycardia and fetal tachycardia and consequently hemodynamic impairment. 2. Case Report A 29-year-old woman was referred for evaluation of suspected fetal arrhythmia in the 23rd week of her pregnancy. Obstetric ultrasonography was negative for fetal anomalies. Fetal echocardiography showed an enlarged and mobile ASA extending as much as 50% into the left atrium and frequent PACs. She was scheduled for weekly hospital visits to allow for early detection of potentially serious fetal arrhythmias. Beginning from 30th week of gestation, brief but frequent (lasting for 3–5?min with 5?min intervals) episodes of fetal bradycardia due to blocked bigeminal PACs were observed, with ventricular rates varying between 80 and 100?bpm. Differential diagnosis between paradoxical bradycardia due to blocked PACs and 2?:?1 atrioventricular (AV) block seen in fetuses of women with collagen tissue disease was done using

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