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Review
. 2022 Apr 11;22(1):311.
doi: 10.1186/s12884-022-04655-6.

Atypical fetal junctional ectopic tachycardia: a case report and literature review

Daisuke Katsura  1 , Shunichiro Tsuji  2 , Shinsuke Tokoro  2 , Takako Hoshiyama  2 , Shinsuke Hoshino  3 , Ouki Furukawa  3 , Takashi Murakami  2
Affiliations
Review

Atypical fetal junctional ectopic tachycardia: a case report and literature review

Daisuke Katsura et al. BMC Pregnancy Childbirth. .

Abstract

Background: Junctional ectopic tachycardia (JET) is caused by ectopic rhythms, originating in the atrioventricular node, typically with heart rate between 200 and 250 bpm. Herein, we present a case of fetal JET with normal fetal heart rate and a review of nine cases.

Case presentation: A 32-year-old, gravida 2, para 1, woman in whom fetal JET could not be diagnosed prenatally because the fetal heart rate was within the normal range. The fetus was diagnosed with premature restriction of the foramen ovale, and a cesarean section was performed, owing to the right heart overload that was characterized by fetal ascites and abnormal fetal Doppler velocity. Postnatally, the female neonate was diagnosed with JET on a 12-lead electrocardiogram, which revealed a neonatal heart rate of 158 bpm with narrow QRS and atrioventricular dissociation. After failure to respond to amiodarone therapy, she was treated with flecainide, which controlled the JET rate from 120 to 150 bpm. Fetal tachycardia with ventriculo-atrial (VA) dissociation or 1:1 VA conduction with a shorter VA interval than that of atrioventricular reentrant tachycardia confirmed the diagnosis of fetal JET.

Conclusions: JET should be suspected even in the absence of tachycardia in patients with ductus venosus and pulmonary vein retrograde flow or tricuspid and mitral regurgitation without a cardiac anomaly, as tachycardia might sometimes be intermittent in cases of JET.

Keywords: Cardiac arrhythmia; Case report; Diagnosis; Junctional ectopic tachycardia; Premature restriction of the foramen ovale; hydrops fetalis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Neonatal 12-lead electrocardiogram. Junctional ectopic tachycardia with narrow QRS and ventriculo-atrial dissociation. The ventricular and atrial rates were 158 and 125 bpm, respectively. The electrocardiogram was recorded at an amplitude of 10 mm/mV and at 25 mm/s
Fig. 2
Fig. 2
Fetal M-mode ultrasound. Ventriculo-atrial dissociation in atypical junctional ectopic tachycardia; junctional ectopic tachycardia was diagnosed postnatally, and the findings were detected retrospectively. In the four-chamber view of the heart, which shows the left ventricle and right atrium, the wide arrow indicates atrial contraction, the narrow arrow indicates ventricular contraction, and the arrowhead indicates a premature ventricular contraction
See this image and copyright information in PMC

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