Introduction
The intricate development of the fetal conduction system is essential for the establishment of a functional cardiovascular system. Disruptions in the conduction pathways during fetal life can lead to serious consequences, impacting both prenatal and postnatal well-being. Disturbances of fetal cardiac rhythm are reported to occur in 1 to 3 % of all the pregnancies and 10% of these can be life-threatening.1 While most are benign, certain types like supraventricular or ventricular tachycardia, atrial fibrillation, and atrioventricular (AV) block may lead to severe complications.2 Transient fetal arrhythmias are more common, but persistent severe bradycardia and sustained tachycardia can result in fetal hydrops, preterm delivery, and increased morbidity and mortality.3 Hence, early diagnosis before progression to hydrops, is both crucial and challenging and requires a specialized team with expertise in fetal echocardiography. The etiology of fetal conduction disturbances is diverse, encompassing ischemia, inflammation, electrolyte imbalances, structural defects, and inherited genetic conditions.4 Understanding the underlying causes and effective management strategies for these abnormalities is vital for improving prenatal care and neonatal outcomes. In this study, we present a retrospective analysis of a cohort comprising 40 cases of fetal arrhythmias diagnosed and managed in our institute with an aim to contribute valuable insights into the diverse challenges encountered.