Cardiovascular Journal of Africa: Vol 25 No 2(March/April 2014) - page 23

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 2, March/April 2014 AFRICA 61
paths, accessory pathways link the atrium and ventricles.
According to Lupoglazoff and Denjoy, 70% of babies less than
three months old with SVT have WPW pattern.18 In a study by
Gillijam et al.,15 the rate of WPW syndrome was 34%. Kundak et
al. 19 studied 55 newborns with malignant rhythms; 22 had SVT
and six had WPW syndrome.
In our study, three patients had WPW syndrome. In another
study,20 90 babies had WPW syndrome, one-third of whom had
repeating SVT episodes after the age of one year. In this study,
the majority of babies were given prophylactic anti-arrhythmia
treatment. In our study, all three babies with WPW syndrome
were given propranolol prophylaxis. These babies did not have
an SVT episode during the long-term follow-up period, even
after the newborn period.
Gillijam et al.15 reported that most babies with a history
of SVT had taken anti-arrhythmia treatment for 6–12 months
after the last SVT episode. In our study, only five patients with
SVT had repeating episodes beyond the newborn period, and it
persisted beyond the age of one year in only two patients, which
is compatible with the literature.
Ventricular tachyarrhythmia, while rare in the newborn
period, generally develops secondary to metabolic anomalies,
such as hyperkalaemia, hypoglycaemia, metabolic acidosis and
hypoxia. It resolves quickly with treatment of the underlying
cause.21,22 In a study by Kundak et al. 19 six patients had ventricular
tachycardia, and three had SVT accompanied by ventricular
tachycardia. In our study, none of the patients with metabolic
acidosis, sepsis and hypoglycaemia had ventricular tachycardia.
A proportion of newborn arrhythmias are a continuation of
arrhythmias that began in the foetal period and extend into the
postnatal period. Fifty per cent of patients who had isolated
supraventricular premature beats were referred in the foetal
period because of irregular heart rhythm. Less than 10% of foetal
arrhythmias are in the form of continuous tachyarrhythmia and
bradyarrhythmia.23 The most common foetal tachyarrhythmias
are tachycardia with frequent supraventricular premature beats,
SVT, AF and, rarely, ventricular tachycardia.
Foetal supraventricular premature beats have a very good
prognosis but 0.4% of cases may advance to life-threatening
tachyarrhythmia.24 Foetal AF is mostly associated with structural
cardiac anomalies; 7–43% of them progress to hydrops.25 The
most important cause of foetal bradycardia is congenital AV
block. Fifty per cent of foetal bradycardia foetuses have mothers
with connective tissue diseases, such as lupus and Sjogren’s
disease. The remaining 50% have underlying complex cardiac
anomalies. 26
In our study, 23 (34%) newborns had arrhythmias diagnosed
in the foetal period. Three of these had SVT, and two had AF.
One had complete AV block, and one had 2:1 AV block. Hydrops
developed in one patient with foetal SVT.
Conclusion
Although the frequency of arrhythmias in the newborn period
is not high, supraventricular premature beats and SVT are the
most frequently observed arrhythmias in this period. Diagnosis
of arrhythmias in the prenatal period is essential for appropriate
and optimal treatment in the postnatal period. Although the long-
term prognosis for newborn arrhythmias is very good, patients
should be monitored at appropriate intervals.
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