Comparative characteristics of fetal cardiac function and hemodynamics based on echocardiographic findings in cases of supraventricular tachycardia that developed before 27.6 weeks of gestation and between 28 and 40 weeks of pregnancy

Clinically significant fetal and neonatal arrhythmias occur in approximately 1 in 4,000 newborns and represent an important cause of morbidity and mortality. The most common arrhythmia is supraventricular tachycardia (SVT), which accounts for 70–75% of fetal cardiac rhythm disorders.

Objective. To compare cardiac contractile function and the hemodynamic state of fetuses with SVT that developed before 27.6 weeks of gestation versus SVT manifesting at 28–40 weeks of gestation.

Materials and Methods. The study was conducted from 2020 to 2024 and included 90 fetuses with the sustained form of SVT: 31 fetuses developed SVT before 27.6 weeks, and 59 fetuses presented with SVT after 28 weeks. The obtained findings were compared with corresponding parameters in control groups of 37 and 68 fetuses without cardiac rhythm disturbances at 20–27.6 weeks and 28–40 weeks of gestation, respectively.

Fetal cardiac contractile function was assessed using M-mode, the Fetal HQ program, Simpson’s method, and pulsed-wave Doppler evaluation of semilunar valve flow parameters. The overall fetal hemodynamic status was evaluated according to the cardiovascular profile score (J.C. Huhta, 2005; C.B. Falkensammer, J.C. Huhta, 2001).

Results. The study revealed distinct features of fetal cardiac function during the supraventricular tachyarrhythmia at different gestational ages. Across all gestational periods, SVT led to reduced transverse and longitudinal myocardial contractility; however, cardiac dysfunction was more pronounced when SVT developed before 27.6 weeks compared to onset after 28 weeks.

Before 27.6 weeks of gestation, left ventricular (LV) function was more significantly impaired, with marked reductions in both systolic and diastolic function, whereas after 28 weeks LV contractile alterations were minimal. In the right ventricle, before 27.6 weeks, diastolic function is impaired; after 28 weeks, systolic function is more significantly reduced.

Cardiac remodeling associated with SVT results in increase of  atrial and central venous pressures, impaired hepatic venous outflow, development of hepatic congestion, heart failure, and progression to non-immune hydrops fetalis. The degree and  severity of hydrops was significantly greater in fetuses with SVT onset before 27.6 weeks compared with those affected at 28–40 weeks of gestation (p < 0.001).

Conclusions. Fetal SVT at any gestational age leads to a reduction in myocardial contractile function; however, the earlier in gestation supraventricular tachycardia develops, the more severe the manifestations of cardiac failure. 

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