Neurological morbidity after fetal supraventricular tachyarrhythmia

Background Fetal tachyarrhythmia is a well-documented entity which, in the absence of pharmacological intervention, may lead to congestive heart failu re, fetal hydrops and eventually fetal demise. The success rate of the impl emented treatment is generally measured by survival and achievement of cont rol of the arrhythmia. We report on the occurrence of associated cerebral d amage in three patients with fetal tachycardia. Methods We describe three patients with a history of fetal supraventricular tachyarrhythmia who developed cerebral complications in utero. Results Two patients had cerebral hypoxic-ischemic lesions and one had hemo rrhagic lesions present at birth. They had developed severe congestive hear t failure and fetal hydrops secondary to fetal tachyarrhythmia, and there w ere no other obvious causes for the cerebral pathology. Two of these patien ts were referred to us antenatally Therapy was instituted and resulted in c ontrol of the tachycardia and resolution of hydrops. The third patient was referred to our clinic shortly after birth because of severe circulatory pr oblems secondary to fetal tachyarrhythmia. Conclusion From these observations, we believe that a fetus with tachyarrhy thmia and subsequent hydrops is at increased risk for the development of ce rebral complications, due to the circulatory disturbances and sudden change s in heart rate which may lead to fluctuations in cerebral perfusion. This would imply that it is of the utmost importance to aim at immediate and com plete control of the heart rate in the treatment of fetal tachyarrhythmia.