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Objective To determine the prognostic significance of cardiac arrhythmia detected in the first trimester. Design Cases in which embryonic arrhythmia was detected by transvaginal ultrasound between 6 and 9 weeks of gestation were retrospectively identified and reviewed. Results Embryonic arrhythmia was noted in four of 950 ultrasound examinations. There was associated ventricular bradycardia in three cases, one of which also had an atrial rate below the normal range for gestational age. No cardiac activity was detected at the follow-up examination 1 week later in three cases. In the other, the embryo was alive but there was severe growth delay and the scan the following week confirmed embryonic death. Conclusion This report suggests that arrhythmia in early pregnancy is associated with subsequent pregnancy loss. [ABSTRACT FROM AUTHOR]