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(Circulation. 2003;107:307.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Magnetocardiographic Rhythm Patterns at Initiation and Termination of Fetal Supraventricular Tachycardia

R.T. Wakai, PhD; J.F. Strasburger, MD; Z. Li, MS; B.J. Deal, MD; N.L. Gotteiner, MD

From the Department of Medical Physics (R.T.W., Z.L.), University of Wisconsin-Madison; Department of Pediatrics, Division of Cardiology (J.F.S.), Children’s Hospital of Wisconsin, Milwaukee; and Department of Pediatrics, Division of Cardiology (B.D., N.G.), Children’s Memorial Hospital, Chicago, Ill.

Correspondence to Ronald Wakai, PhD, Department of Medical Physics, 1300 University Ave, Madison, WI 53706. E-mail rtwakai{at}wisc.edu

Background— Using fetal magnetocardiography (fMCG), we characterize for the first time the electrophysiological patterns of initiation and termination of reentrant fetal supraventricular tachycardia (SVT), the most common form of life-threatening fetal arrhythmia.

Methods and Results— In contrast to the expectation that reentrant SVT is initiated by spontaneous premature atrial contractions (PACs) and is terminated by spontaneous block, 5 distinct patterns of initiation and 4 patterns of termination were documented, with the most common patterns of initiation involving reentrant PACs. Waveform morphology and timing, including QRS and ventriculoatrial interval, were assessed. This enabled detection of such phenomena as Wolff-Parkinson-White syndrome, QRS aberrancy, and multiple reentrant pathways that were crucial for defining the rhythm patterns. In addition, fMCG actocardiography revealed an unexpectedly strong association between fetal trunk movement and the initiation and termination of SVT, suggesting that autonomic influences play a key role.

Conclusions— This study demonstrates that the patterns of initiation and termination of fetal SVT are more diverse than is generally believed and that the most common patterns of initiation involve reentrant PACs. The ability to discern such patterns can help elucidate the underlying mechanisms and guide antiarrhythmic drug therapy. fMCG provides a noninvasive means of analyzing complex tachyarrhythmia in utero, with efficacy approaching that of postnatal electrocardiographic rhythm monitoring.

Key Words: electrophysiology • arrhythmia • tachycardia

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