Amiodarone and digoxin for refractory fetal tachycardia

Arnoux, Philippe; Seyral, Philippe; Llurens, Michele; Djiane, P; Potier, A.; D, Unal; Cano, Jean Paul; Serradimigni, A; Rouault, F

doi:10.1016/s0002-9149(87)80095-4

Cited by 58 publications

(12 citation statements)

References 6 publications

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“…3 There are 69 reported cases of amiodarone use during pregnancy in which the infants' thyroid function was documented. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] In all, 16 infants developed hypothyroidism 3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18] ( Table 1), and two developed hyperthyroidism. 18,19 The overall incidence of hypothyroidism was 23% (16/69).…”

Section: Discussionmentioning

confidence: 99%

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Amiodarone-Induced Neonatal Hypothyroidism: A Unique Form of Transient Early-Onset Hypothyroidism

2004

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Amiodarone is an iodine-rich drug used to treat cardiac dysrhythmias. The structure of amiodarone resembles that of thyroxine, and treatment with amiodarone may alter thyroid function. The effects of antenatal amiodarone use on fetal/neonatal thyroid function have only been addressed in a limited number of patient reports. We describe two cases of transient neonatal hypothyroidism due to in utero amiodarone exposure, followed by a brief review of the available literature.

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Section: Discussionmentioning

confidence: 99%

“…3 The effects of amiodarone during pregnancy on neonatal thyroid function have only been addressed in a limited number of reports. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] We describe two patients with transient neonatal hypothyroidism due to in utero amiodarone exposure.…”

Section: Introductionmentioning

confidence: 99%

Amiodarone-Induced Neonatal Hypothyroidism: A Unique Form of Transient Early-Onset Hypothyroidism

2004

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“…In the first 2 cases (1981 and 1982) propafenone or p-methyldigoxin and fiecainide were injected once together into the umbilical vein by ultrasound guid ance [4,8], Thereby, cardioversion into sinus rhythm was reached for 90 and 300 min. respectively.…”

Section: Methodsmentioning

confidence: 99%

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Gembruch

Hansmann²,

Bald³

1988

Fetal Diagn Ther

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In cases of non-immune hydrops fetalis caused by tachyarrhythmias, the transplacental passage of antiarrhythmic drugs may be hampered. When this is proven by fetal blood sampling in cases of tachyarrhythmia refractory to transplacental treatment, additional administration of antiarrhythmic drugs into the fetus is necessary and seems to improve the results. Although injections of antiarrhythmic agents in fetal ascites are also highly effective, intravascular administration by sonographic guidance is to be preferred. Then, simultaneous measurements of fetal and maternal drug levels are possible for the evaluation of pharmacokinetics and for monitoring the antiarrhythmic therapy.

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“…Although ECG effects were noted postnatally, profound bradyarrhythmias necessitating emergent delivery or severe conduction defects, such as reported with flecainide, 17 were not noted. Amiodarone has been shown in many pediatric studies 9,19 -22 and in anecdotal accounts in the fetus 18,[23][24][25][26] to be highly efficacious when other drugs have failed. Crossover efficacy for amiodarone for reentrant SVT was seen in this series and has been reported in other fetal studies for both flecainide and sotalol response failures.…”

Section: Amiodarone Efficacy and Safetymentioning

confidence: 99%

Amiodarone Therapy for Drug-Refractory Fetal Tachycardia

et al. 2004

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Background-Fetal tachycardia complicated by ventricular dysfunction and hydrops fetalis carries a significant risk of morbidity and mortality. Transplacental digoxin is effective therapy in a small percentage, but there is no consensus with regard to antiarrhythmic treatment if digoxin fails. This study evaluates the safety, efficacy, and outcome of amiodarone therapy for digoxin-refractory fetal tachycardia with heart failure. Methods and Results-Fetuses with incessant tachycardia and either hydrops fetalis (nϭ24) or ventricular dysfunction (nϭ2) for whom digoxin monotherapy and secondary antiarrhythmic agents (nϭ13) were not effective were treated transplacentally with a loading dose of oral amiodarone for 2 to 7 days, followed by daily maintenance therapy for Ͻ1 to 15 weeks. Digoxin therapy was continued throughout gestation. Newborns were studied by transesophageal pacing or ECG monitoring to determine the mechanism of tachycardia. Three fetuses were delivered urgently in tachycardia during amiodarone loading, and 3 required additional antiarrhythmic agents for sustained cardioversion. Amiodarone or amiodarone combinations converted 14 of 15 (93%) with reentrant supraventricular tachycardia, 2 of 2 with ventricular or junctional ectopic tachycardia, and 3 of 9 (33%) with atrial flutter. Amiodarone-related adverse effects were transient in 5 infants and 8 mothers. Mean gestational age at delivery was 37 weeks, with 100% survival. Conclusions-Orally administered amiodarone is safe and effective treatment for drug-refractory fetal tachycardia, specifically reentrant supraventricular tachycardia, junctional ectopic, or ventricular tachycardia, even when accompanied by hydrops fetalis or ventricular dysfunction.

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Amiodarone and digoxin for refractory fetal tachycardia

Cited by 58 publications

References 6 publications

Amiodarone-Induced Neonatal Hypothyroidism: A Unique Form of Transient Early-Onset Hypothyroidism

Amiodarone-Induced Neonatal Hypothyroidism: A Unique Form of Transient Early-Onset Hypothyroidism

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Amiodarone Therapy for Drug-Refractory Fetal Tachycardia

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