Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T10:52:53.423Z Has data issue: false hasContentIssue false
  • English
  • Français

Rapid control of foetal supraventricular tachycardia with digoxin and flecainide combination treatment

Published online by Cambridge University Press:  29 September 2011

Orhan Uzun ,
Kadir Babaoglu ,
Anju Sinha ,
Spyridon Massias  and
Bryan Beattie
Orhan Uzun*
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Kadir Babaoglu
Affiliation:
Department of Paediatric Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkiye
Anju Sinha
Affiliation:
Department of Obstetric and Gynaecology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Spyridon Massias
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Bryan Beattie
Affiliation:
Department of Obstetric and Gynaecology, University Hospital of Wales, Cardiff, Wales, United Kingdom
*
Correspondence to: Dr O. Uzun, Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, United Kingdom. Tel: 02920744743; Fax: 02920744744; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

To evaluate the efficacy of flecainide and digoxin combination in foetal supraventricular tachycardia.

Setting

This study was carried out in a tertiary referral centre.

Methods

We conducted a retrospective review of 29 patients diagnosed with supraventricular foetal tachycardia between 2001 and 2009. Mode of presentation, foetal cardiac function, maternal anti-arrhythmic serum levels, drug tolerance, and maternal electrocardiogram recordings were assessed. The postnatal outcome of each infant was also evaluated for tachycardia recurrence.

Results

In all, 27 foetuses were treated with digoxin and flecainide combination, and two foetuses were delivered without any treatment. Of the 27 foetuses, seven had atrial flutter and the remaining 22 had atrioventricular re-entry tachycardia. There were eight foetuses with hydrops (27%), of whom three had atrial flutter and five had atrioventricular re-entry tachycardia; 26 foetuses (96%) responded to flecainide and digoxin combination, with restoration of sinus rhythm in 22 (81.4%) and rate control in the other four. In one severely hydropic foetus, there was no response to treatment. In all, 26 treated infants were delivered alive, but one pregnancy was terminated for non-cardiac causes when the foetus was in sinus rhythm. There was no intrauterine death due to tachycardia. Although there were minor side effects to anti-arrhythmic medications, none of the pregnant women developed proarrhythmia.

Conclusion

Flecainide and digoxin combination treatment offers a safe and effective treatment for foetal supraventricular tachycardia with fast restoration of sinus rhythm.

Keywords

Foetusarrhythmiaanti-arrhythmic drugsdigoxinflecainide
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 4 , August 2012 , pp. 372 - 380
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Simpson, JM, Sharland, GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart 1998; 79: 576–581.CrossRefGoogle ScholarPubMed
2. Frohn-Mulder, IM, Stewart, PA, Witsenburg, M, Den Hollander, NS, Wladimiroff, JW, Hess, J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diagn 1995; 15: 1297–1302.CrossRefGoogle ScholarPubMed
3. Texter, KM, Kertesz, NJ, Friedman, RA, Fenrich, AL Jr. Atrial flutter in infants. J Am Coll Cardiol 2006; 48: 1040–1046.CrossRefGoogle ScholarPubMed
4. Hansmann, M, Gembruch, U, Bald, R, Manz, M, Redel, DA. Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases. Ultrasound Obstet Gynecol 1991; 1: 62–70.CrossRefGoogle ScholarPubMed
5. Kleinman, CS, Copel, JA. Direct fetal therapy for cardiac arrhythmias: who, what, when, where, why and how? Ultrasound Obstet Gynecol 1991; 1: 158–160.CrossRefGoogle Scholar
6. Strasburger, JF, Cuneo, BF, Michon, MM, et al. Amiodarone therapy for drug-refractory fetal tachycardia. Circulation 2004; 109: 375–379.CrossRefGoogle ScholarPubMed
7. Oudijk, MA, Visser, GH, Meijboom, EJ. Fetal tachyarrhythmia – Part II: treatment. Indian Pacing Electrophysiol J 2004; 4: 185–194.Google ScholarPubMed
8. Hornberger, LK, Sahn, DJ. Rhythm abnormalities of the fetus. Heart 2007; 93: 1294–1300.CrossRefGoogle ScholarPubMed
9. Ebenroth, ES, Cordes, TM, Darragh, RK. Second-line treatment of fetal supraventricular tachycardia using flecainide acetate. Pediatr Cardiol 2001; 22: 483–487.CrossRefGoogle ScholarPubMed
10. Oudjik, MA, Michon, MM, Kleinman, CS, et al. Sotalol in the treatment of fetal dysrhythmias. Circulation 2000; 101: 2721–2726.CrossRefGoogle Scholar
11. DeVore, GR. Assessing fetal cardiac ventricular function. Semin Fetal Neonatal Med 2005; 10: 515–541.CrossRefGoogle ScholarPubMed
12. Lulić Jurjević, R, Podnar, T, Vesel, S. Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias. Cardiol Young 2009; 19: 486–493.CrossRefGoogle ScholarPubMed
13. Huntley, M. The Griffiths mental developmental scales manual from birth to two years. Association for Research in Infant and Child Development, Bucks, UK; The Test Agency, Oxford, UK, 1996, pp. 5–39.Google Scholar
14. Van Engelen, AD, Weijtens, O, Brenner, JL. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol 1994; 24: 1371–1375.CrossRefGoogle ScholarPubMed
15. Jaeggi, E, Fouron, JC, Drblik, S. Atrial flutter in the fetal period: diagnosis, clinical features, treatment and outcome. A review. J Paediatr 1998; 132: 335–339.CrossRefGoogle Scholar
16. Lisowski, LA, Verheijen, PM, Benatar, AA, et al. Atrial flutter in the perinatal age group: diagnosis, management and outcome. J Am Coll Cardiol 2000; 35: 771–777.CrossRefGoogle ScholarPubMed
17. Maxwell, D, Crawford, D, Curry, P, Tynan, M, Allan, L. obstetric importance, diagnosis and management of fetal tachycardias. BMJ 1988; 297: 107–110.CrossRefGoogle ScholarPubMed
18. Hahurij, ND, Blom, NA, Lopriore, E, et al. Perinatal management and long-term cardiac outcome in fetal arrhythmia. Early Hum Dev 2011; 87: 83–87.CrossRefGoogle ScholarPubMed
19. Krapp, M, Baschat, AA, Gembruch, U, Geipel, A, Germer, U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2002; 19: 158–164.CrossRefGoogle ScholarPubMed
20. Echt, DS, Liebson, PR, Mitchell, B, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The cardiac arrhythmia suppression trialIssueN Engl J Med 1991; 324: 779–788.Google ScholarPubMed
21. Oudijk, MA, Gooskens, RH, Stoutenbeek, P, De Vries, LS, Visser, GH, Meijboom, EJ. Neurological outcome of children who were treated for fetal tachycardia complicated by hydrops. Ultrasound Obstet Gynecol 2004; 24: 154–158.CrossRefGoogle ScholarPubMed