III. 5. 2. Atrial flatter

          Fetal atrial flatter, re-entran SVT'lerden daha az sıklıkta görülür ve kontrol edilmesi daha zordur. Re-entran taşikardilere göre yapısal kardiyak anormallikler daha sık görülür. Atrial dilatasyonu olan fetüslerde daha sık karşılaşılmaktadır. Altta yatan kardiyak patoloji, atrial hız ve atrioventriküler blok'un derecesi fetüsün duruma tahammül etme gücünü etkiler. Atrial hız 450/dakika dolaylarındadır ve hemen daima !/2 veya 1/3 atrioventriküler blok vardır. Bloğun derecesi ventriküler hızı belirler. Ventriküler hızın derecesi de fetal kardiyak yetmezliğin dolayısıylada hidropsun oluşup oluşmamasını etkiler. Tedavi SVT tedavisi ile benzerdir. Burada da sıklıkla ilk tercih edilecek ajan digoksindir. Ancak sıklıkla kinidin ve prokainamid gibi ikincil bir ajana gereksinim duyulur (66).

III. 5. 3. Ventriküler taşikardi:

          Ventriküler taşikardi, fetüsde oldukça ender görülen bir taşikardi türüdür ve tanısı zordur. Çünkü ventriküler uyarı retrograt olarak atriuma ulaşır ve kasılmasına neden olur. Kardiyak hız 180-200/dakikadır. Bu nedenle sıklıkla iyi tolere edilir. M-mode ekokardiografide ventriküler veya atrial atımın hangisinin öncül olduğunun saptanması mümkün olmayabilir. Bu nedenlerden dolayı kesin tanı konulması mümkün olmayabilir (72).

III. 6. Sonuç:

          Sonuç olarak: İntrauterin antiaritmik tedaviye başlamadan önce ileti anormalliğinin kesin tanısı konulmaya çalışılmalı, yapısal kardiyak anormallik olup, olmadığı saptanmalı, miada yakın gebeliklerde doğum ya da intrauterin tedavi seçimi, gestasyonel yaşa veya fetal akciğer matürasyonuna göre belirlenmeli, intrauterin tedavinin fayda ve zararları iyi belirlenmeli, tedavi süresince anne ve fetüs monitorize edilmeli ve aileden tüm bu bilgilerin verildiğine yönelik kabul formu alınmalıdır. Optimal sonuç için pediatrik kardiolog ve obstetrisyen arasında sıkı işbirliği kırulmalıdır. Bu nedenlerden dolayı bu tür tedavi, söz edilen tüm önlemlerin alınabileceği, gerekli ekip ve donanımın olduğu tersiyer merkezlerde mümkündür. Fetal tedavinin ilk ve en yüz güldürücü alanlarından olan fetal antiaritmik tedavi ancak bu şekilde optimum sonuçları verecektir.

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