Julia Murlewska¹, Krzysztof Serafin², Iwona Strzelecka^1,3, Maria Respondek-Liberska^1,3

¹Department of Prenatal Cardiology Polish Mother's Memorial Hospital, Research Institute, Łódź, Poland.

²Department of Gynaecology and Obstetrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland.

³Department for Fetal Malformations Diagnoses & Prevention Medical University of Lodz, Faculty of Public Health.

Corresponding author: Julia Murlewska, MD, PhD, Department of Prenatal Cardiology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Łódź Poland. e-mail: juliamurlewska.jm@gmail.com

Citation: Julia Murlewska, Krzysztof Serafin, Iwona Strzelecka, Maria Respondek-Liberska (2025). Recovery of Segmental Ventricular Contractility in a Fetus with Mixed Arrhythmia: Monitoring with Fetal Speckle-Tracking Echocardiography. Euro J Case Rep Clin Imag. 2025; Nov, e11, 1-5.

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Abstract:

Background: Fetal arrhythmias can disrupt coordinated myocardial contraction and, in severe cases, impair cardiac function. While conventional echocardiography assesses global systolic and diastolic performance, subtle segmental disturbances may go undetected. Fetal speckle-tracking echocardiography (STE) provides quantitative evaluation of ventricular mechanics and may offer added value in monitoring therapy response.

Case Presentation: A 30-year-old pregnant woman at 27+3 weeks’ gestation was referred for suspected fetal arrhythmia. She had occupational exposure to various chemicals but no autoimmune antibodies. Fetal echocardiography revealed ventricular bradycardia (93 bpm) with atrial rate of 160 bpm, prolonged atrioventricular conduction with intermittent Wenckebach-type block, frequent atrial and ventricular ectopy, and cardiomegaly (CTAR 0.40).

STE (FetalHQ) demonstrated global segmental left ventricular (LV) dysfunction and right ventricular (RV) impairment except in basal segments, despite no signs of hydrops. Maternal therapy with intravenous dexamethasone and oral salbutamol was initiated. Serial follow-up showed gradual normalization of ventricular rate, regression of cardiomegaly, and progressive recovery of segmental function, culminating in complete restoration of RV contractility and near-normal LV performance by 34+3 weeks.

Conclusions: This case highlights the utility of fetal STE in detecting regional ventricular dysfunction and objectively documenting myocardial recovery in fetuses with mixed arrhythmias. Integration of advanced imaging into routine surveillance may improve assessment of treatment efficacy, guide management, and provide reassurance to both clinicians and parents when rhythm stabilization leads to functional recovery.