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Doppler echocardiographic isovolumetric time intervals in diagnosis of fetal blocked atrial bigeminy and 2:1 atrioventricular block
Author(s) -
Sonesson S.E.,
Eliasson H.,
Conner P.,
WahrenHerlenius M.
Publication year - 2014
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.13344
Subject(s) - isovolumetric contraction , medicine , cardiology , fetus , atrioventricular block , diastole , pregnancy , biology , blood pressure , genetics
ABSTRACT Objective To distinguish between blocked atrial bigeminy ( BB ) and incomplete atrioventricular block with 2:1 conduction (2:1 AVB ) can be very difficult, especially in the mid‐term fetus. Making a correct diagnosis has important clinical implications, as their prognosis and management differ markedly. Our objective was to investigate whether analysis of isovolumetric time intervals could improve Doppler echocardiography in differentiating these conditions. Methods Sixteen fetuses with sustained BB or isolated 2:1 AVB , diagnosed at our tertiary center from 2002 to 2012, were reviewed retrospectively. Doppler recordings of left ventricular in‐ and outflow, including mitral and aortic valve movements, were used to measure isovolumetric contraction ( ICT ) and relaxation ( IRT ) time intervals. ICT reference values obtained from 104 normal pregnancies were used for comparison. Results Ten fetuses had BB and six 2:1 AVB . Five of the AVB cases were anti‐Ro antibody positive and one had long QT syndrome ( LQTS ). ICT was systematically shorter in BB than in antibody‐mediated 2:1 AVB . Nine of 10 cases with BB had an ICT below −2 SD and the five with antibody‐mediated 2:1 AVB had values at or above +2 SD . All 15 fetuses with either BB or antibody‐mediated AVB had an IRT of < 70 ms, as opposed to a markedly prolonged IRT (105 ms) in the LQTS case. Conclusion Measurement of ICT can improve the differential diagnosis between BB and antibody‐mediated 2:1 AVB . Fetuses with BB or antibody‐mediated AVB are unlikely to have IRT measurements exceeding 70 ms and, when this is observed, LQTS should be considered a more likely diagnosis. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd