CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014
AFRICA
59
Permanent junctional reciprocating tachycardia (PJRT) was
the final diagnosis in patients with foetal cardiomyopathy after
delivery. In addition, two babies had atrial flutter. All four
of these patients were delivered at 37 weeks. The remaining
baby was diagnosed in the 34th week with SVT. Digoxin was
given to the mother. However, when rhythm control could not
be maintained, sotalol was added and a partial response was
achieved. The baby was delivered at 38 weeks. Babies who had
complete AV block and 2:1 AV block were not treated in the
intrauterine period.
Twenty cases (30.3%) had accompanying congenital heart
diseases. Atrial septal defect (ASD) was the most common
cardiac pathology. Fifteen babies had ASD, ventricular septal
defect or patent ductus arteriosus. Two babies, both of whom
were term, had patent ductus arteriosus. Term babies with
spontaneously closed ductus arteriosus after the first week
were not included in this data. No premature baby subsequently
showed patent ductus arteriosus after discharge. In babies with
ASD, all defects were small or medium sized. Five babies had
complex congenital heart diseases, such as AV septal defect,
tetralogy of Fallot, or double-inlet left ventricle.
Twenty-six patients had supraventricular premature beats and
four had ventricular premature beats. Anti-arrhythmia treatment
was given for two weeks to three months to only six patients who
had frequent or couplet–triplet supraventricular premature beats
or short-duration SVT attacks determined by 24-hour Holter
monitoring. Supraventricular premature beats continued for one
year in seven patients.
After discharge, SVT did not occur in any patient with
supraventricular premature beats. Patients with ventricular
premature beats did not have any anti-arrhythmia treatment, and
no additional arrhythmia occurred after the newborn period.
Eleven babies had bradyarrhythmia, four of whom had sinus
bradycardia. One had hypocalcaemia (DiGeorge syndrome), one
had hypoglycaemia, and one had long QT syndrome. One baby
did not have any pathology. One baby had bradyarrhythmia with
Table 1. Demographic features of the study group.
Demographic features
Number
(mean
±
standard deviation)
Sex, M/F
45/21
Gestational age (week)
Preterm delivery
Term delivery
38.1
±
2 (34–41)
11
55
Delivery mode
Normal
28
Caesarian
38
Apgar score (5 minutes)
8.5
±
2
Birth weight (g)
3 258
±
508.6 (2 200–4 500)
Table 2. Distribution and clinical characteristics of patients diagnosed with arrhythmia in the neonatal period
Arrhythmia type
n
(%) Accompanying congenital heart disease (
n
)
Accompanying other extracardiac problems
Irregular heart rhythm (ectopic beats) 30 (45.4)
Supraventricular premature beats
26 (39.3) VSDm (1), ASD (1), VSD + ASD (2), ASD
+ BAV (1), AVSD + HRV (2)
A-V malformation
Ventricular premature beats
4 (6)
ASD (1), VSDm (1)
Bradyarrhythmias
11 (16.6)
Sinus bradycardia
3 (4.5)
VSDp (1)
Hypocalcaemia + DiGeorge (1), hypoglycaemia (1)
2:1 AV block
3 (4.5)
TOF (1), atrial isomerism (1)
Sepsis
Complete AV block
3 (4.5)
PDA (1), DILV (1)
Hypothyroidism
Intraventricular block
1 (1.5)
–
Hyperkalaemia (CAH)
Long QT
1 (1.5)
–
–
Tachyarrhythmia
25 (37.8)
Sinus tachycardia
2 (3)
–
–
Supraventricular tachycardia
23 (34.8)
AVRT*
16 (24.2)
Partial AVSD (1), ASD (3)
Diaphragmatic hernia (1), co-anal atresia (1)
Atrial flutter
5 (7.5)
PDA (1), ASD (1)
Metabolic asidosis, diaphragmatic hernia, hypoglycaemia
MAT
1 (1.5)
–
–
PJRT
1 (1.5)
Dilated cardiyomyopathy (1)
Foetal hydrops
Total
66 (100)
ASD: atrial septal defect, AV: atrioventricular, A-V: arteriovenous, AVSD: atrioventricular septal defect, AVRT: atrioventricular re-entrant tachycardia,
BAV: bicuspid aortic valve, DILV: double-inlet left ventricule, HRV: hypoplastic right ventricule, CAH: congenital adrenal hyperplasia, MAT: multifocal
atrial tachycardia, PDA: patent ductus arteriosus, PJRT: permanent junctional reciprocating tachycardia, TOF: tetralogy of Fallot, VSDm: muscular ventric-
ular septal defect, VSDp: perimembranous septal defect.
*Three babies had WPW.
Table 3. The types and frequency of arrhythmias
diagnosed in the foetal period
Arrhythmia type
Number of cases
(
n
= 23)
Percent (%)
Irregular heart rhythm (ectopic beats)
15
65.2
Supraventricular premature beats
13
56.5
Ventricular premature beats
2
8.7
Bradyarrhythmias
3
13
Sinus bradycardia
1
4.3
2:1 AV block
1
4.3
Complete AV block
1
4.3
Tachyarrhythmia
5
21.7
Supraventricular tachycardia
3
13
Atrial flutter
2
8.7
AV: atrioventricular.
