In Europe, standard factors are 20 BPM/cm (vertical) and 1 or 2 cm/minute (horizontal). However, if the reflecting interface is the surface of a moving organ such as the fetal heart, there will be a frequency change (Doppler shift) in the reflected signal.
This form of short-term memory is supported by the prefrontal cortex (PFC) and is believed to rely on the ability of selectively tuned pyramidal neuron networks to persist in firing even after a to-be-remembered stimulus is removed from the environment. Figure 4.4. M-mode and pulsed Doppler ultrasound assessment of severe fetal bradycardia. J Am Heart Assoc. Currently, ultrasound is the only widely used method of studying fetal anatomy and physiology, but it has significant limitations for assessment of cardiac rhythm. [7] reported that the prevalence of fetal bradyarrhythmias was 3.4% (62/1821). A 10-year observational study on the pregnant women demonstrated 29 cases of fetal arrhythmias: 12 (41.4%) of which were fetal tachycardias (10 cases with SVT, 2 cases with atrial flutter (AF)), 5 (17.2%) were fetal bradyarrhythmias (all 5 cases with AV block), and 12 (41.4%) were fetal irregular cardiac rhythms (premature atrial beats) [4]. Fetal tachyarrhythmias are usually SVT (63.4%), AF (28.0%) and VT (8.5%).
Mark Klimek's lecture notes - Lecture 1 Acid-Base Balance Ventilators Keywords. D Maternal fever. Watch this videoFor any support, please contact Mindray India on the below . Am J Cardiol. California Privacy Statement, Besides, immediate cardioversion was also observed in a fetus receiving intraumbilical injection of amiodarone. PubMedGoogle Scholar.
Difference Between Arrhythmia and Dysrhythmia Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Front Pharmacol. With older monitors, the quality of the Doppler-created FHR tracing is directly related to the orientation of the signal to the fetal heart, the amount of fetal movement, and the degree of constant attention by nursing personnel of maintaining an adequate signal while caring for the patient. The World Health Organization (WHO 2014) stated that between 2000 and 2050, the proportion of the world`s population over 60 years of age will double from about 11 % to 22 %. It is often temporary and . fetal arrhythmia vs artifact. Fetal tachyarrhythmia - part II: treatment. volume46, Articlenumber:21 (2020) 2005;10:50414. (From Klapholz H, Schifrin BS, Myrick R et . J Obstet Gynaecol India. One of the most useful and commonly used diagnostic tools is electrocardiography (EKG) which measures the heart's electrical activity as waveforms. Prenat Diagn. The role of echocardiography in fetal tachyarrhythmia diagnosis. Article
Fetal Mediastinal Mass Associated with Arrhythmia: Artifact and Casual 2013 Sep;42(3):285-93. doi: 10.1002/uog.12390. Most are brief, fleeting occurrences of slow or fast heartbeat or irregular heart rhythm. (eds) 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007. 2023 BioMed Central Ltd unless otherwise stated.
fetal arrhythmia vs artifact - chamberlainfunding.com 2023 Feb 18;13(4):779. doi: 10.3390/diagnostics13040779. Doctors have been using ECG signals to detect heart diseases such as arrhythmia and myocardial infarctions for over 70 years. The time to conversion to sinus rhythm for sotalol varied from 1 to 5days (median 1day) for Shah et al.
ECG-based machine-learning algorithms for heartbeat classification - Nature In hydropic cases, a same trend was observed (86% vs. 38%, P=0.07 for flecainide vs. digoxin), while the successful rate of combined flecainide with amiodarone was 100%. It is the process of signal conversion to FHR that differs.
Prophylactic Administration of Mesenchymal Stromal Cells Does Not Abstract 20644: Comparison of efficacy and safety of first-line transplacental treatment of fetal supraventricular tachycardia (SVT) and atrial flutter (AF) with sotalol, flecainide and digoxin. Sustained fetal arrhythmias associated with major structural heart disorders, hydrops fetalis, and fetal heart failure warrant intrauterine pharmaceutical conversion of heart rhythm or early pacemaker implant in order to avoid fetal demise. The principles underlying the use of Doppler FHR monitoring are described. HUM 100 Cultures and Artifacts Worksheet; Newest. Regular screening by fetal echocardiography and transplacental treatment could prevent this risk factor [9]. No Comments . In comparison to flecainide or digoxin, sotalol was less effective to convert SVT to sinus rhythm. PubMedGoogle Scholar, Faculty of Electrical Engineering, University of Ljubljana, Trzaska 25, 1000, Ljubljana, Slovenia, Tomaz Jarm,Peter Kramar&Anze Zupanic,&, Cesarelli, M., Romano, M., Bifulco, P., Fratini, A. The fetal thymus is a structure that usually goes unnoticed during the process of prenatal diagnosis, and when it presents alterations in its morphology, can lead to confusion and cause fetal arrhythmias without an adverse clinical outcome. Thesis. Kardia Advanced Determination "Sinus with Supraventricular Ectopy (SVE)" indicates sinus rhythm with occasional irregular beats originating from the top of the heart.
EFM certification Flashcards | Quizlet Europ. Comani S, Liberati M, Mantini D, Gabriele E, Brisinda D, Di Luzio S, et al. Fetal cardiac rhythm abnormalities are common and are encountered in about 1% to 2% of pregnancies ( 1 ). Google Scholar.
Fetal Arrhythmia: Diagnosis & Treatment - SSM Health Objective: To assess whether noninvasive fetal electrocardiography (NI-FECG) enables the diagnosis of fetal arrhythmias. Both, artifacts and cardiac arrhythmias represent outliers of the FHR signals, so they affect both time domain and time frequency signal analysis. Fetal arrhythmia is rare. In cases of refractory SVT with severe hydrops fetalis, the treatment regimen can be a maternal oral loading dose of 200mg, followed by fetal intraperitoneal dose of 47mg/kg. An official website of the United States government. 2015;79:85461. Int J Cardiol. Bookshelf The high risks of perinatal demise was often associated with fetal hydrops, structural defects, poor ventricular function and HR <55bpm. Fetal heart arrhythmias and doppler ultrasound. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. The frequency increases if the reflecting interface is moving toward the signal source and decreases if the reflecting interface is moving away from the signal source. In fetuses with short VA tachycardia, it may display a distinctive Doppler flow velocity pattern with a 1:1 AV conduction and a tall A wave superimposed on the aortic ejection wave. IEEE Trans.Biomed.Eng. Heart Rhythm. 2009;29:2923. Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols.
Novii Wireless Patch System - GE Healthcare Can digoxin and sotalol therapy for fetal supraventricular tachycardia and hydrops be successful? The conversion rate to sinus rhythm of flecainide for short VA SVT was higher than digoxin (96% vs. 69%, P=0.01). Benign fetal arrhythmias, such as premature contractions and sinus tachycardia, do not need any perinatal treatments. -stimulants, such as ritodrine, terbutaline, and salbutamol, and steroids have been reported to be effective transplacental treatments for fetal AV block, and they may increase fetal ventricular rate by 1020% and reverse hydrops as well. The fetuses with corrected transposition of the great arteries or ventricular rate70bpm had a better survival rate. PubMed Central Strasburger JF. However, this results may be compromised when the fetus is in an improper position for simultaneous recordings [17]. Google Scholar. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. Some artifact can mimic lethal dysrhythmias such as ventricular tachycardia with brushing your teeth or ventricular fibrillation with tapping on the electrode. Arrhythmia. The occurrence of paroxysmal AF can be a result of TBX5 gain-of-function mutations and overexpressions of Nppa, Cx40, Kcnj2 and Tbx3 genes [7]. Congenital complete heart block: fetal management protocol, review of the literature, and report of the smallest successful pacemaker implantation. Miyoshi T, Maeno Y, Sago H, Inamura N, Yasukochi S, Kawataki M, et al. AlSoufi M. Successful treatment of fetal tachycardia by sotalol. Among other causes, the fetal arrhythmia is accountable for a significant portion of such . The authors declare that they have no competing interest. 50, no. Zhi-Yang Xu. 2010;81:84450. Cite this article. The treatment of choices for fetal tachyarrhythmias was listed in Table2. These keywords were added by machine and not by the authors. Springer Nature. Moreover, fetal cardiac arrhythmias can have an effect on FHR signals. Capuruo CA, Mota CC, Rezende GD, Santos R. P06.03: fetal tachyarrhythmia: diagnosis, treatment and outcome. Currently, in cardiotocographic devices, Doppler methodology involves autocorrelation techniques to recognize heart beats, so evaluation of inter-beats time-interval is very improved. 1,6 Fetal . 2018;11:349. Ultrasound Obstet Gynecol. For fetuses with hydrops and fetal SVT with long VA interval, digoxin is rarely effective. Despite various electronic logic and filtering processes, this often results in an apparent increase in short-term variability due to a false reproduction of the actual interval from one heart beat or R wave (contraction) to the next (, Although not new in concept, the application of autocorrelation to FHR technology has been made possible by the introduction of high-speed microprocessor integrated circuitry. Cardiol Young. Fetal Diagn Ther. It connects to the Corometrics 259cx Series .
fetal arrhythmia vs artifact - waterfresh.gr Fetal arrhythmias: premature atrial contractions and supraventricular tachycardia. Despite apparent improvement in signal interpretation, autocorrelation is still not a true measure of short-term variability. https://doi.org/10.1007/978-3-540-73044-6_205, DOI: https://doi.org/10.1007/978-3-540-73044-6_205, Publisher Name: Springer, Berlin, Heidelberg, eBook Packages: EngineeringEngineering (R0). Strizek et al. 2003;29:S85. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. HUM 100 Cultures and Artifacts Worksheet; Problem Set Week1 - Week One Assignment; 1-7 HW Key - Problems and answers . 2019;69:3836.
Fetal Arrhythmia - American Pregnancy Association Shah A, Moon-Grady A, Bhogal N, Collins KK, Tacy T, Brook M, et al. PubMed Central A transducer innovation employed by second-generation monitors is pulsed Doppler. This is a preview of subscription content, access via your institution. Sotalol is usually well-tolerated and has little or no negative inotropic effect on the fetal heart. Your doctor may discover this anomaly when doing a routine ultrasound or listening to your baby's . Fetal direct intramuscular injection of digoxin with maternal amiodarone use is an effective alternative. Abstract. An EKG uses electrodes attached to the skin . Fetal arrhythmia is often found during fetal heart monitoring or routine prenatal ultrasound examination. Both MCG and ECG may provide useful information on cardiac time intervals, such as the QRS and QT durations. Methods: A total of 500 echocardiography and NI-FECG recordings . A case report. The ability to distinguish one from the other requires knowledge of FHR and MHR characteristics and monitoring technology. 2004;24:1127. Transplacental administration of steroids, such as dexamethasone and betamethasone, are effective for fetal AV block caused by positive maternal autoantibodies. Semin Fetal Neonatal Med. fetal arrhythmia vs artifactdiscretionary housing payment hackney. An arrhythmia is an irregular rhythm of the heart in which abnormal electrical signals through the heart muscle may cause the heart to beat too fast (tachycardia), too slowly (bradycardia), or in an erratic pattern. J Obstet. Correspondence to It is believed that the circuit is completed through the fetal umbilical cord, placenta, and the maternal circulation and that the potential difference (voltage) being measured is between the two poles. Pediatr Cardiol. It is more effective than digoxin, especially for hydropic fetal tachycardia, with no adverse fetal outcomes found [14]. It should be used with small doses cross the placenta [31]. In fetuses with premature contractions, fetal echocardiogram is useful for cardiac structural and functional assessments, and for disclosing the mechanisms of fetal isolated PACs and multiple ectopic beats [21]. This is the sound that is heard using a Doppler device. 2017;9:00322 http://medcraveonline.com/JCCR/JCCR-09-00322.php. Irregular fetal cardiac rhythm is the leading cause for referrals to fetal echocardiography centers for rhythm disturbances, and the vast majority of those are benign atrial ectopic beats.
Fetal arrhythmia: Prenatal diagnosis and perinatal management What is Sinus Rhythm with Supraventricular Ectopy? The angle of reflection varies according to the angle of incidence of the beam. FOIA If the FHR exceeds 240 BPM, not even a direct fetal ECG system will count every beat and may halve or not print such rates. 2009;3:2537. Machado MV, Tynan MJ, Curry PV, Allan LD. The transplacental administration of combined digoxin and flecainide is an effective regimen for SVT with long VA interval [32].
Fetal Monitoring IP Assessment 2022 PYLE.pptx - Intrapartal 14,15 This may be achieved by: conversion to sinus rhythm; or ventricular rate control. Fetal arrhythmia is an abnormal fetal heartbeat or rhythm. The aim of the present study is to discuss the complex and challenging issue concerning the prenatal evaluation and intrauterine therapeutics of fetal arrhythmias. Novii provides the opportunity to enhance your current Labor and Delivery monitoring experience.
fetal arrhythmia vs artifact Fetal complete heart block. Circulation. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias. In: Jarm, T., Kramar, P., Zupanic, A. 2004;27:164755. Fetal atrial flutter: electrophysiology and associations with rhythms involving an accessory pathway. 2017;7:e016597. 2018;31:40712. 8,12,16 The use of fetal echocardiography, M-mode and pulse-wave Doppler has lead to improved diagnosis of fetal arrhythmias, and remains the cornerstone of diagnosis. The amplified electrical signal can also be used as a counting source for an FHR monitor. Instrumentation and Artifact Detection Including Fetal Arrhythmias. Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics. Also, because of the high sensitivity to ambient noise, the technique is unsatisfactory for monitoring during the active phase of labor (. government site. Note the two rates are identical in detail. The "a" prefix in arrhythmia means a lack or an absence of something. Fetal magnetocardiography (MCG) allows real-time detection and classification of arrhythmias [18] with better signal quality than electrocardiography due to more favorable transmission properties of the magnetic signals. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Utilitarian Function : Shelter, clothing . Meanwhile, "dys" is . Besides, 16 (84.2%) cases had sick sinus syndrome. Fetal monitoring interpretation. The neonatal and overall survival rates for fetal bradyarrhythmia with structural heart disease were much higher, which were 66 and 48%, respectively. The heart [] Both, artifacts and cardiac arrhythmias represent outliers of the FHR signals, so they affect both time domain and time frequency signal analysis. Keywords . However, recorded FHR signals may contain artifacts, because of the possible degradation, or even less, of the Doppler signal due to relative motion between probe and fetal heart, maternal movements, muscle contractions and other causes. National Library of Medicine
Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics The management protocols are shown in Table1. 11th Mediterranean Conference on Medical and Biomedical Engineering and Computing 2007 pp 789792Cite as, Part of the IFMBE Proceedings book series (IFMBE,volume 16). Arrhythmias are discovered in about 1% of fetuses. Antenatal antiarrhythmic treatment for fetal tachyarrhythmias: a study protocol for a prospective multicentre trial. Carpenter RJ Jr, Strasburger JF, Garson A Jr, Smith RT, Deter RL, Engelhardt HT Jr. Fetal ventricular pacing for hydrops secondary to complete atrioventricular block. Hydrostatic pressure within the uterus should be equal at all points. The signal actually received is a composite consisting of bursts with various amplitudes and frequencies. Oral flecainide (100mg three times daily) is reserved for those cases unresponsive to sotalol and digoxin [34]. Fetal premature ventricular contractions https://radiopaedia.org/articles/fetal-premature-ventricular-contractions. One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. 2009;29:68290. Pacemaker implantation was warranted in 17 (89.5%) cases. Fetal atrial flutter (AF) and supraventricular tachycardia (SVT) resemble in terms of the effects of intrauterine therapies. This section will deal with the methodology involved in the clinical application of these techniques. Intraperitoneal, intraamniotic, and intramuscular injections allow instant delivery of the drugs while the fetuses carry less traumatic injuries [27]. Both fetal magnetocardiogram and electrocardiogram provide information of . 2 years ago. Most disturbances of fetal cardiac rhythm are isolated extrasystoles that are of little clinical importance. 2009;2:195207. Fetal bradycardias may be due to sinus bradycardia, blocked PACs, or high degree AV block [46]. The proposed framework uses only a single abdomen ECG. If maternal transplacental treatment fails, direct administrations, such as intraumbilical, intraperitoneal, or intramuscular injection of antiarrhythmic agents can be considered as alternative approaches. Thus, it is not helpful in diagnosing fetal rhythm and conduction disorders with irregular heart rates. Besides, sustained fetal arrhythmias predispose to the occurrence of hydrops fetalis, cardiac dysfunction, or even fetal demise [10]. Prog Pediatr Cardiol. Digoxin, flecainide and sotalol can be the first-line treatments. 5,6 Heart rates less than 100bpm are classified as bradycardia, and rates greater than 180bpm are identified as tachycardia. 2015;25:44753. The institutional Review Board approves this study. Gozar L, Marginean C, Toganel R, Muntean I. Cardiotocography is the most commonly used noninvasive diagnostic technique that provides physicians information about fetal development (in particular about development of autonomous nervous system - ANS) and wellbeing. ADVERTISEMENTS. Accessibility Cookies policy. If the electrodes are changed more often - especially for overweight people or people, who sweat very intensely - the occurrence of artifacts are avoided. An arrhythmia is an irregular heart rate too fast, too slow, or otherwise outside the norm. Shetty A, Radswiki. Provided by the Springer Nature SharedIt content-sharing initiative. May be caused by fetal arrhythmias, recording of MHR, or the wrong paper speed. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Stirnemann J, Maltret A, Haydar A, Stos B, Bonnet D, Ville Y.
OB/Geri Exam 1 Study Guide - OB/Geri Exam 1 Study Guide Geri: Intro what is multiplicative comparison. Fetal cardiac pacings are effective methods to restore sinus rhythm in drug-resistant or hemodynamically compromised cases. Alsaied T, Baskar S, Fares M, Alahdab F, Czosek RJ, Murad MH, et al.
Artifacts vs. Arrhythmia - Autonom Health B. Maternal hypotension. 2004;52:13847. Uterine contraction intensities. The FHR monitor acquires, processes, and displays an electronic signal. Signorini, G. Magenes, S. Cerutti, D. Arduini (2003) Linear and nonlinear parameters for the analysis of fetal heart rate signal from cardiotocographic recordings. Master of Engineering.
What happens if my prenatal doctor hears a fetal heart arrhythmia Most of the rapid fetal arrhythmia is a nonorganic lesion, mostly transient. Fetal demise occurred in 5 (26.3%), and neonatal death in 10 (41.7%). if you have areas where it's uniform aka a fully colored in area, no breaks, like a big block of spikes . van der Heijden LB, Oudijk MA, Manten G, ter Heide H, Pistorius H, Freund MW. Multifocal atrial and ventricular premature contractions with an increased risk of dilated cardiomyopathy caused by a Nav1.5 gain-of-function mutation (G213D). For fetuses with hydrops, the placental transfer of the digoxin is limited. Krapp M, Baschat AA, Gembruch U, Geipel A, Germer U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. However, they can be severe sometimes leading to cardiac compromise. Circ J. The transplacental administration of antiarrhythmic agents, including digoxin, flecainide, sotalol, and amiodarone, is applied for fetal tachycardia in many centers [25]. C. Umbilical vein compression. The effect of intrauterine therapy of fetal tachyarrhythmias depends on the types or etiology of fetal arrhythmia and fetal conditions (hydrops fetalis, cardiac function, and maternal autoantiboy positivity, etc.). Part of Springer Nature. Fetal echocardiography has been the mainstay of fetal arrhythmia diagnosis; however, fetal magnetocardiography (fMCG) has recently become clinically available. In 2 cases, maternal QRS complexes which were detectable at the fetal scalp electrode were counted, resulting in misleading recordings. Up-to-date .
A Machine Learning Framework for Fetal Arrhythmia - SpringerLink It is within this group of rhythm disturbances that the majority of fetal . Rev Med Suisse. PACs are usually benign and often resolve spontaneously, but follow-up is necessary for preventing from developing into ventricular tachycardia [22]. First-generation monitors calculate heart rate by electronic integration and peak detection of the returning Doppler signal. Arrhythmia vs Dysrhythmia. 2012 Jun 1;109(11):1614-8. doi: 10.1016/j.amjcard.2012.01.388. Burne - Jones ) Rhythm II. Fetal arrhythmia has various types and different prognosis.
Noninvasive fetal electrocardiography for the detection of fetal Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, et al. Fetal congenital arrhythmia is an irregular beating of the heart of a fetus, caused by a congenital disability or an inherited genetic condition. Use this EKG interpretation cheat sheet that summarizes all heart arrhythmias in an easy-to-understand fashion. Ultrasonic signals can penetrate human tissue. 2012;109:16148. In general, digoxin is widely accepted as a first-line antiarrhythmic drug.
Cardiac arrhythmias and artifacts in fetal heart rate signals Flecanide and sotalol cross the placental barrier easier, especially in hydropic fetuses, and a higher drug concentration can be achieved in the amniotic fluid. [41] Freedom from arrhythmia on maintenance therapy was 93 and 90% at 1 and 3months, respectively. Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics, https://doi.org/10.1186/s13052-020-0785-9, https://radiopaedia.org/articles/fetal-premature-ventricular-contractions, https://doi.org/10.1136/bmjopen-2017-016597, http://medcraveonline.com/JCCR/JCCR-09-00322.php, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. BMJ Open. Shah et al. The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed. Bigeminy does not always cause symptoms. . It is indicated for fetal long QT syndrome type 2 and complete AV block [45]. The upper panel shows the heart rate from a fetal scalp electrode (FHR) and maternal leads (MHR) with a dead fetus. TMJ. Phonocardiography was the first method used to record FHR electronically. With such a system, both technical and logistic problems exist, such as catheter occlusion by solid matter, kinking or entrapment of catheter between the uterus and the fetus, as well as introduction of artifact secondary to maternal movement and catheter manipulation (, The pressure within the uterine cavity is directly proportional to the uterine wall tension and inversely proportional, Insertion of the uterine pressure catheter is accomplished by introducing it, while within the sterile introducer tube, just inside the uterine cervix and next to the presenting part (, Another modification of the intrauterine pressure catheter allows for amnioinfusion while simultaneously recording contraction strength directly (see, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Instrumentation and Artifact Detection Including Fetal Arrhythmias, Liability and Risk Management in Fetal Monitoring, Clinical Management of Abnormal Fetal Heart Rate Patterns, Alternative and Backup Methods to Improve Interpretation of Concerning FHR Patterns, Fetal Heart Rate Patterns Associated with Fetal Central Nervous System Dysfunction, Evaluation and Management of Fetal Heart Rate Patterns in Premature Gestation, Antepartum Management of the High-Risk Patient. 3, Department of Electronic and Telecommunication, University "Federico II", Via Claudio, 21, Naples, Italy, Mario Cesarelli,M. Romano,P. Bifulco&A. Fratini, You can also search for this author in Prenatal Diagnosis of Fetal Heart Failure. Springer, Berlin, Heidelberg. https://doi.org/10.1161/JAHA.117.007164. Eng. The prevalence of rapid fetal arrhythmia, especially SVT, is relatively high, accounting for 0.40.6% of all fetuses. Therefore, the fetal electrocardiogram (ECG) signal provides the clinician with a measure of the electrical activity of the fetal heart. M-mode ultrasound can detect the AV and ventriculoatrial (VA) intervals, fetal heart rate, AV conduction, and even ejection fraction [11], but detection qualities may be compromised by early detection in first trimester, unfavorable fetal position, hydrops fetalis, fetuses with cardiac contractile dysfunction and obese pregnant women [12]. Treatment success was defined as conversion to sinus rhythm, or rate control, defined as >15% rate reduction [14].
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