Management of Fetal Arrhythmias

Prompt recognition and treatment of hemodynamically significant fetal arrhythmias is paramount to achieving an optimal outcome. As our diagnostic capabilities expand, there is ample opportunity to improve management strategies including initiating targeted therapy based on mechanism of fetal arrhythmia identified on fetal echocardiogram and/or fetal ECG/MCG. The most recent advancements in diagnostic capabilities using fetal ECG/MCG have allowed for risk stratification of fetuses with or at risk for fetal long QT syndrome. Home fetal heart rate monitoring and its importance in management of fetal atrioventricular block pose great promise in altering the guarded prognosis that currently exists for these patients. The spectrum of fetal arrhythmias is substantial. Current ongoing prospective clinical trials will add invaluable information regarding the ideal antiarrhythmic agent for fetal tachyarrhythmias as well as the most effective management protocol to halt the progression to autoimmune-mediated complete atrioventricular block. Wider appreciation of the fetus at risk for arrhythmias and the ensuing evaluation by fMCG and surveillance by echocardiography and adjunct tools will improve both pre- and postnatal outcomes.