Fetal Intervention for Refractory Supraventricular Tachycardia Complicated by Hydrops Fetalis

Abstract

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 be therapeutic and decrease maternal adverse effects associated with more toxic effects of other transplacental medications.

Unexplained fetal tachycardia: A case report

“…The FHR returned to normal on the fourth day of medication, and the foramen ovale returned to normal after treatment[ 9 ]. Munoz et al [ 10 ] provided a unique treatment method: Intrauterine intramuscular injection of digoxin alleviated refractory fetal supraventricular tachycardia accompanied by fetal edema, which could be completely resolved by one-time injection. Yuan et al [ 11 ] administered sotalol orally to 10 mothers with fetal tachycardia (atrial fibrillation) for 7 d. Eight of these mothers had a conversion back to normal sinus rhythm, and one died after the dosage was increased.…”

A Rare and Challenging Case of Refractory Fetal Supraventricular Tachycardia

“…For example, in a 2017 multicenter study, cases of SVT were considered refractory if first-line therapy failed [ 13 ]. Another report considered cases to be refractory if there was no improvement or if deterioration of fetal status was seen despite therapeutic levels [ 14 ]. Due to the critical nature of refractory cases and the lack of consensus for treatment regimen, there should be strong familiarity with treatment options for refractory cases to ensure patients are managed appropriately and quickly enough to avoid morbidity and mortality.…”