Introduction Sustained fetal bradycardia is a rare condition that occurs in < 3% of term infants and in 5% of post-term pregnancies. Fetal bradycardia and other fetal arrhythmias are associated with congenital long Q-T syndrome.
Case A fetus underwent echocardiographic evaluation at 34 weeks of gestation for sustained bradycardia at 95 to 100 bpm. The study demonstrated 1:1 atrioventricular (AV) conduction and normal cardiac anatomy and function. The fetus remained stable throughout pregnancy without signs of congestive heart failure. After delivery, at 37 weeks' gestation, the electrocardiogram showed sinus rhythm at 99 bpm with a prolonged Q-Tc interval of 608 msec. Because of sinus bradycardia, the infant underwent permanent pacemaker implantation and, following the pacemaker, was placed on propranolol. After the diagnosis was made in this patient, evaluation of family members revealed that two maternal uncles have long Q-T syndrome, and one older brother and three cousins have a borderline Q-Tc.
Conclusion Fetal bradycardia with 1:1 AV conduction may be the first sign of long Q-T syndrome, a potentially lethal genetic condition. Early diagnosis, along with institution of appropriate therapy in the patient and previously undiagnosed affected relatives, may avoid fatalities. The team approach to this and other fetal cardiac conditions is critical. Coordination between the perinatologist and pediatric cardiologist optimally guides obstetric and postnatal management.
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