Atrial arrhythmias are commonly found during fetal echocardiography performed during pregnancy to evaluate fetal arrhythmias. An association between atrial arrhythmias and an atrial septal aneurysm has been noted in children and adults. In this study, 105 fetuses were evaluated by fetal echocardiography, 39 (37%) referred to evaluate fetal arrhythmia and 66 (63%) to rule out congenital heart disease. An atrial septal aneurysm was found in 42 (40%) of the fetuses and an atrial arrhythmia in 37 (35%). An atrial septal aneurysm was found in 25 (64%) of the 39 fetuses referred to evaluate a fetal arrhythmia compared with only 17 (26%) of the 66 fetuses referred to rule out congenital heart disease. In this study, the association of an atrial septal aneurysm with an atrial arrhythmia was highly significant (p less than 0.001).