Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know

Abstract

Fetal supraventricular tachycardia management is challenging, with consequences for both the fetus and the mother. If left untreated, fetal hydrops may ensue, at which point delivery and treatment of the arrhythmia is preferred. However, if the fetus is not at term nor near-term, significant doses of antiarrhythmics may be needed to achieve adequate transplacental bioavailability. Although digoxin has classically been the mainstay of treatment, the use of flecainide or sotalol as monotherapy or in combination with digoxin is being studied. Interdisciplinary team management and shared decision-making between the physician and patient are key to achieving successful outcomes. Adult cardiologists, particularly inpatient consultation services or through burgeoning cardio-obstetrics programs, may, in some practice settings, be asked to evaluate or comanage pregnant women with fetal arrhythmia.

Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

“…Depending on the medication, antiarrhythmic therapy can cause nausea, vomiting, extreme tiredness, and elevated BNP (brain natriuretic peptide) concentrations. 30,32…”

“…Depending on the medication, antiarrhythmic therapy can cause nausea, vomiting, extreme tiredness, and elevated BNP (brain natriuretic peptide) concentrations. 30,32 Direct monitoring of the fetus for drug toxicity is difficult, although serial Doppler measurements of the atrioventricular interval may demonstrate 10 to 30 milliseconds of prolongation or intermittent AVB. Once drug levels are therapeutic and the fetal heart rhythm is controlled, weekly fetal heart rate monitoring and echocardiograms at 2-to 4-week intervals are suggested.…”

Unexplained fetal tachycardia: A case report

“…This indicated that sotalol was more efficient in treating fetal atrial fibrillation but less effective for other arrhythmias, especially for the fetus with supraventricular tachycardia, where the fatality rate was higher[ 12 ]. However, Purkayastha et al [ 13 ] pointed out that the management of fetal supraventricular tachycardia with flucanide or sotalol as monotherapy or in combination with digoxin might be the main approach, but this needs to be further evaluated in a practical setting. O'Leary et al [ 14 ] examined 57 cases of fetal persistent tachycardia at 13–37 wk under the control of digoxin, flucanide, sotalol, and amiodarone.…”

Fetal Arrhythmia Diagnosis and Pharmacologic Management

“…Rarely, amniotic fluid reduction procedures have been necessary. To our knowledge, maternal death from fetal tachyarrhythmia drug treatment has not been reported, but side effects are common and usually well tolerated 30 . These are often specific to the drug and are more common when drugs are given concurrently, in quick succession, or rapidly escalated.…”

“…To our knowledge, maternal death from fetal tachyarrhythmia drug treatment has not been reported, but side effects are common and usually well tolerated. 30 These are often specific to the drug and are more common when drugs are given concurrently, in quick succession, or rapidly escalated. Daily inpatient electrocardiograms and heart monitoring or telemetry are indicated during initiation of drug therapy.…”