Intrauterine therapy for fetal supraventricular tachycardia in a twin pregnancy (original) (raw)
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Fetal Intervention for Refractory Supraventricular Tachycardia Complicated by Hydrops Fetalis
Case Reports in Obstetrics and Gynecology, 2022
Introduction. Few reports have shown promising treatments for refractory fetal tachycardia. Data are limited regarding optimal treatment, route of treatment, and medication dosages. Over 90% of cases of fetal tachycardia can be attributed to supraventricular tachycardia (SVT). The first-line treatment of fetal SVT is transplacental digoxin. Case Presentation. We present the management of a patient with fetal tachyarrhythmia diagnosed at 24 weeks and offer a unique approach for treatment. Fetal intramuscular injection of 72.3 mcg of digoxin allowed for resolution of SVT and sustained normal sinus rhythm. Further assessment in the third trimester showed persistent hydrops in the setting of mirror (Ballantyne’s) syndrome resulting in delivery. Discussion/Conclusion. Our observations suggest that a one-time injection of digoxin allows for complete resolution of SVT. Utilizing an invasive approach for management of SVT that is resistant to traditional treatment modalities appears to both...
Medicina
We present a special case of fetal supraventricular tachycardia detected at 34 weeks gestation. Fetal hydrops was noted on ultrasound upon admission. Normal fetal heart rate was maintained for three weeks by maternal administration of digoxin. A live infant was delivered via caesarian section at 37 weeks gestation. This clinical case demonstrated that pharmacological treatment can be effective and helps to prolong pregnancy safely.
Fetal supraventricular tachycardia diagnosed and treatedat 13 weeks of gestation: a case report
Ultrasound in Obstetrics and Gynecology, 2003
When SVT is sustained, congestive heart failure and fetal hydrops may ensue, due to both systolic and diastolic dysfunction. Sonographic diagnosis is usually incidental during the second or third trimester. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal SVT diagnosed at 13 weeks of gestation. Treatment with digoxin and flecainide was successful; the heart rate returned to sinus rhythm within one day, and fetal hydrops resolved within 8 days of treatment. We suspect that as more first-trimester examinations are performed, more cases with SVT will be diagnosed. We discuss the treatment protocol, and suggest that co-administration of two drugs that act synergistically may be more efficient than monotherapy, which is currently used as the first line of treatment. In addition, we discuss the potentially deleterious effect of heart failure encountered at an early developmental stage on the central nervous system. More data need to be collected in order to substantiate a clear recommendation regarding optimal management.
Indian Journal of Medical Sciences, 2009
Sustained fetal supraventricular tachycardia (SVT) with a heart rate of approximately 210 bpm may lead to increased atrial and venous pressures and congestive heart failure. There is no clear consensus regarding the best drug-treatment regimens for fetal SVT. However, considerable nonrandomized experience in the transmaternal treatment of fetal SVT is available with a number of antiarrhythmic agents. We report a case of fetal supraventricular tachyarrhythmia with hydrops detected at 32 weeks that was managed with combination of oral digoxin and sotalol and review management guidelines available in the literature.
Fetal supraventricular tachycardia at 12 weeks of gestation: diagnosis and follow up. A case report
Medical Ultrasonography
This report describes a case of fetal supraventricular tachycardia (SVT) diagnosed at 12 weeks of gestation in a pregnant woman with diabetes mellitus. Transplacental digoxin therapy administered orally to the mother was unsuccessful. Subsequently, sotalol was added to digoxin to achieve fetal heart rate (HR) control and the conversion to sinus rhythm was achieved. The fetal HR remained stable until term, and a healthy male baby was born. The newborn electrocardiogram showed sinus rhythm with normal PR and QTc intervals. When the newborn was stable, he was discharged with propanolol. Sustained SVT is extremely rare during the first trimester. The goal of treatment in utero is the conversion to sinus rhythm or reduction of the ventricular rate to tolerable levels, preventing or even reversing fetal hydrops.
Case Reports in Perinatal Medicine, 2018
Background Fetal supraventricular tachycardia (SVT) is a reversible cause of fetal hydrops, with better outcomes if detected early and reverted in utero. Modern imaging allows accurate diagnosis and maternal anti-arrhythmic therapy can be practiced ensuring in utero cardioversion. Case presentation We present a case of preterm fetal hydrops due to SVT successfully reverted in utero by multidrug maternal therapy. The mother presented to our tertiary care hospital at 32 weeks’ gestation with a fetal heart rate of 229 beats/min with evidence of mild fetal pericardial effusion and ascites. Under strict maternal monitoring, the treatment was started with parenteral digoxin. Flecainide, sotalol and amiodarone were introduced sequentially based on the response until cardioversion was achieved at 35 weeks with no maternal side effects. She labored spontaneously and delivered a 2.6 kg baby boy 4 days after the successful cardioversion. The baby was discharged home on day 7 on oral amiodarone...
Digoxin and Amiodaron in Fetal Sustained Supraventricular Tachycardia and Nonimmune Hydrops
Gynaecologia Et Perinatologia, 2011
Supraventricular tachycardia is the most common and clinically significant form of sustained fetal tachyarrhythmia in pregnancy; depending on duration and high rate variability heart failure and nonimmune hydrops may develop which are associated with a high incidence of perinatal mortality. Doppler/echo diagnosis is usually accidental during second and third trimester of pregnancy. Therapeutic goals are cardioconversion to sinus rhythm and recovery of heart failure. We present a case of fetal supraventricualr tachycardia diagnosed at 29 weeks of gestation with nonimmune hydrops. Treatment with digoxin and amiodarone was successful. The heart rate restored to sinus rhythm and nonimmune hydrops resolved within three weeks of treatment. Therapy with two drugs that act synergistically may be more efficient than monotherapy in blocking likely atrio-ventricular reentry mechanism by accessory pathway in sustained supraventricular tachycardia, thus allowing resolution of hydrops with favorable management outcome.
Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias
Journal of the American College of Cardiology, 2019
BACKGROUND Standardized treatment of fetal tachyarrhythmia has not been established. OBJECTIVES This study sought to evaluate the safety and efficacy of protocol-defined transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL). METHODS In this multicenter, single-arm trial, protocol-defined transplacental treatment using digoxin, sotalol, and flecainide was performed for singleton pregnancies from 22 to <37 weeks of gestation with sustained fetal SVT or AFL $180 beats/min. The primary endpoint was resolution of fetal tachyarrhythmia. Secondary endpoints were fetal death, pre-term birth, and neonatal arrhythmia. Adverse events (AEs) were also assessed. RESULTS A total of 50 patients were enrolled at 15 institutions in Japan from 2010 to 2017; short ventriculoatrial (VA) SVT (n ¼ 17), long VA SVT (n ¼ 4), and AFL (n ¼ 29). One patient with AFL was excluded because of withdrawal of consent. Fetal tachyarrhythmia resolved in 89.8% (44 of 49) of cases overall and in 75.0% (3 of 4) of cases of fetal hydrops. Pre-term births occurred in 20.4% (10 of 49) of patients. Maternal AEs were observed in 78.0% (39 of 50) of patients. Serious AEs occurred in 1 mother and 4 fetuses, thus resulting in discontinuation of protocol treatment in 4 patients. Two fetal deaths occurred, mainly caused by heart failure. Neonatal tachyarrhythmia was observed in 31.9% (15 of 47) of neonates within 2 weeks after birth. CONCLUSIONS Protocol-defined transplacental treatment for fetal SVT and AFL was effective and tolerable in 90% of patients. However, it should be kept in mind that serious AEs may take place in fetuses and that tachyarrhythmias may recur within the first 2 weeks after birth.
An enhancement of coronary blood flow in a fetus with supraventricular tachycardia
Prenatal Diagnosis, 2009
Modern obstetric ultrasound has allowed a detailed evaluation of many fetal small arteries in both normal and abnormal conditions. Recently, a study of a very tiny fetal coronary artery has been proved possible when the imaging condition is optimal ). An augmentation of fetal coronary blood flow reflecting an attempt to compensate for an increase in oxygen demand by means of autoregulation process has been demonstrated with Doppler ultrasound in both acute and chronic fetal stress conditions such as acute fetomaternal hemorrhage, fetal ductal constriction, and intrauterine growth restriction (IUGR) . We present herein the first case of coronary blood flow enhancement in a fetus with supraventricular tachycardia (SVT) demonstrated with Doppler ultrasound. The evidence of the enhancement of blood flow disappeared when the fetal heart rate was eventually converted to normal sinus rhythm with maternal ingestion of flecainide.