Challenge of managing opposing rhythms in a mother and fetus

Abstract

Introduction: We report a case of a fetus with complex congenital heart disease and supraventricular tachycardia in the setting of maternal high grade atrioventricular block at 26 weeks' gestation.

Methods and results: Electroanatomic mapping allowed successful implantation of a permanent pacemaker to provide adequate back-up pacing in the mother with zero radiation exposure, thus allowing safe delivery of transplacental anti-arrhythmic medications to reduce the fetal arrhythmia burden and optimize the fetal ventricular rate.

Conclusion: This is the first reported case of using electroanatomic mapping, with zero fluoroscopy use, for pacemaker lead placement and for a novel indication.

Keywords: electroanatomic mapping; fetal SVT; fetal tachycardia; fluoroscopy; fluoroscopy-free; heart block; pacemaker; radiation.