fetal arrhythmias: basics of diagnosis

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11th Annual Fetal Echocardiography Symposium at UCLAFetal Arrhythmias: Basics of Diagnosis

Gary M Satou, MD FASE FAHADirector, Pediatric Echocardiography

Co-Director, Fetal Cardiology Program UCLA Mattel Children’s Hospital

UCLA David Geffen School of Medicine

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Fetal Arrhythmias…

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Heart Block Atrial Flutter

Been around a long time..

1983

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Technology/Evaluation: STIC M-Mode from 4D Volume

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Not Hard ! Basic Electrophysiology Simple Math (focus on mechanical AV relations) “Big Picture”- FHR regular? fast? slow? (AV ratio 1:1 ?) Usual ultrasound tools: 2D, M Mode, Pulse Doppler

11th Annual Fetal Echocardiography Symposium at UCLA

Fetal Arrhythmias: Basics of Diagnosis

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Fetal Arrhythmias: Basics of Diagnosis

Kevin and Jeremy

Best Advice..Ask the electrophysiologists..

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Fetal Arrhythmias: Basics of Diagnosis

Not just clips “Electrical-Physiologic” Correlation Ultrasound tools/modalities Sample Illustrations

11th Annual Fetal Echocardiography Symposium at UCLA

Overview

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Fetal Arrhythmias: Basics of Diagnosis

Anatomy

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PhysiologyElectrical Depolarization

Fetal Arrhythmias: Basics of Diagnosis

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Waveforms

Fetal Arrhythmias: Basics of Diagnosis

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Fetal Arrhythmias: Basics of Diagnosis

Ultrasound Tools/Modalities

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2 Dimensional Imaging

Sinus Tachycardia

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2 Dimensional Imaging

Vent Tachycardia

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M Mode

Ventricular Rate: 200 Atrial Rate: 400

Atrial Flutter (2:1)

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Color M-Mode

Blocked PACs

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Pulsed Wave Doppler

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Pulsed Wave Doppler

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Pulsed Wave Doppler SVC/Aorta

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Pulsed Wave Doppler

SVC/Aorta

MV/AoV

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Fetal Arrhythmias: Basics of Diagnosis

Optimize Image Resolution Zoom in/use Depth Speed (space things out!) Consider labeling

Important: No Matter what modality..

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Fetal Arrhythmias: Basics of Diagnosis

Sample Illustrations

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SR w 1:1 AV conduction

Fetal Arrhythmias: Basics of Diagnosis

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Fetal Arrhythmias: Basics of Diagnosis

SR w PACs

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SR w PACs

SR w PVCs

Fetal Arrhythmias: Basics of Diagnosis

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Fetal Arrhythmias: Basics of Diagnosis

SVT

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Fetal Arrhythmias: Basics of Diagnosis

SVT

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Fetal Arrhythmias: Basics of Diagnosis

3rd degree AVB

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Fetal Arrhythmias: Basics of Diagnosis

Atrial Flutter

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Nothing Magical - Be “simple” & think the “basics” Know: Electrical-Physiologic correlates Ultrasound Tools: 2D, Pulse Doppler, M Mode Big picture: regular? A:V ratio 1:1 ? Too fast? slow?

Fetal Arrhythmias: Basics of Diagnosis

11th Annual Fetal Echocardiography Symposium at UCLA

Best Advice: Ask Someone Else!

SUMMARY

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Thank You

11th Annual Fetal Echocardiography Symposium at UCLA