Abstract 17036: Transesophageal Electrophysiology Study as a Tool to Guide Post-natal Management of Fetal Supraventricular Tachycardia
Background: With advancements in fetal echocardiography, the diagnosis of supraventricular tachycardia (SVT) is now often made antenatally. There is wide variability in the post-natal management and indications to initiate therapy have not been clearly defined. Esophageal recording and pacing is a useful and minimally invasive tool in the assessment and management of SVT. The proximity of the esophagus to the atria in an anatomically normal individual allows for excellent atrial signal recording as well as noninvasive-programmed stimulation to elicit or terminate reentrant SVT. Transesophageal-pacing study (TEPS) has been used to predict clinical recurrence and efficacy of various management strategies in patients with neonatal SVT, but was never used as a tool to guide post-natal management in newborns with a pre-natal diagnosis of SVT.
Hypothesis: Our primary hypothesis is that TEPS can guide post-natal management in patients with fetal SVT. Secondary objectives were to evaluate if fetal echo accurately diagnoses SVT mechanism and to assess the proportion of fetal SVT that will resolve by the time of birth.
Methods: A retrospective review of all cases of fetal SVT at the Hospital for Sick Children of Toronto from 1999 to 2015 was performed.
Results: A total of 66 patients were included. There were 6 intra-uterine demises. Of the liveborns, 41% had spontaneous SVT during the observation period. Of the 59% remaining, half had inducible SVT during the TEPS. Overall, 70% of patients with a fetal diagnosis of SVT had post-natal recurrence, either spontaneous or inducible. None of the “non-inducible patients” had long-term recurrence.
Conclusions: TEPS is a valid tool to evaluate the need for postnatal therapy in fetal SVT. Based on the results, treatment could be safely avoided in approximately a third of the patients. Futures studies should be done to evaluate long-term spontaneous recurrence of SVT in inducible patients without initiation of treatment.
Author Disclosures: C. Renaud: None. J. Vinocur: None. E. Jaeggi: None.
- © 2016 by American Heart Association, Inc.