胎児・新生児頻拍性不整脈12例の臨床像

Clinical Course of 12 Patients with Fetal and/or Neonatal Tachyarrhythmia

要旨

　目的：胎児・新生児頻拍性不整脈の臨床経過から，管理上の注意点を明確にする．

　対象と方法：対象は2001年以降に当院で管理した胎児頻拍性不整脈4例，新生児頻拍性不整脈10例(胎児頻拍性不整脈合併2例を含む)．出生後観察期間の中央値は3年7カ月．①胎児頻拍性不整脈の臨床経過と②診断別出生後経過について後方視的に検討した．

　結果：①胎児頻拍性不整脈；心房粗動2例，上室性頻拍2例．胎児水腫例はなく，3例で胎内治療を行い全例洞調律となった．②診断別出生後経過；心房粗動3例，心房頻拍2例，房室回帰頻拍3例，房室結節回帰頻拍3例，不明1例．急性期治療の反応は良好であったが，6例が再発し，房室回帰頻拍例は2～4回の発作があった．感染症時に4回の頻拍発作を認めた．

　結語：胎児頻拍性不整脈に対する抗不整脈薬母体投与の治療効果は良好で，胎児診断は再発時や出生直後の対応に有用であった．房室回帰頻拍は再発の頻度が高かった．

　Objective: The purpose of this study was to clarify the important points in managing the clinical course of fetal and/or neonatal tachyarrhythmia.

　Subjects and Method: Four cases of fetal tachyarrhythmia,8 cases of neonatal tachyarrhythmia and 2 cases of fetal and neonatal tachyarrhythmia,which had been treated in our hospital since 2001. Median follow-up period after birth was 3 years and 7 months. The Following points were investigated retrospectively: (1)The clinical course of fetal tachyarrhythmia; and (2)The course after birth in each diagnostic category.

　Result: (1)Fetal tachyarrhythmia(atrial flutter,2 cases; and supraventricular tachycardia,2 cases). There was no case of hydrops and 3 cases underwent intra uterine treatment and regained sinus rhythm. (2)The course after birth in each diagnostic category(atrial flutter,3 cases; atrial tachycardia,2 cases; atrioventricular reentry tachycardia,3 cases; atrioventricular nodal reentry tachycardia,3 cases; and one case whose course was unknown). Responses to the treatment at the acute phase were good,but 6 cases relapsed and 2 to 4 attacks were observed in the cases of atrioventricular reentry tachycardia. Due to infection,4 attacks of tachycardia were noticed.

　Conclusion: Maternal administration of an anti-arrhythmic drug was quite effective for fetal tachyarrhythmia,and fetal diagnosis was useful for managing relapse and for neonatal management. Cases of atrioventricular reentry tachycardia relapsed with higher frequency.