Flecainide as first-line treatment for fetal supraventricular tachycardia

Ekiz, Ali; Kaya, Başak; Bornaun, Helen; Açar, Deniz; Avci, Muhittin Eftal; Bestel, Ayşegül; Yıldırım, Gökhan

doi:10.1080/14767058.2017.1286317

Cited by 28 publications

(32 citation statements)

References 18 publications

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“…One single center study with potential overlapping patients in another multi‐center study was included due to a short overlapping period and minimal potential patient duplication . After application of the inclusion/exclusion criteria, 21 studies were eligible for the meta‐analysis (Figure ) …”

Section: Methodsmentioning

confidence: 99%

Transplacental treatment of fetal tachycardia: A systematic review and meta‐analysis

et al. 2017

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Objective Multiple transplacental medications can be used to treat fetal tachycardia. We sought to perform a systematic review and meta-analysis to determine whether digoxin, flecainide, or sotalol was the most efficacious therapy for converting fetal tachycardia to sinus rhythm. MethodWe performed a systematic review and meta-analysis to compare digoxin, flecainide, or sotalol as first-line therapy for fetal tachycardia. Studies were identified by a search of PubMed (Medline), Web of Science, and Scopus.Results There were 21 studies included. Flecainide (OR: 1.4, 95% CI: 1.1-2.0, I 2 = 60%, P = 0.03) and sotalol (OR:1.4, 95% CI:1.1-2.0, I 2 = 30%, P = 0.02) were superior to digoxin for conversion of fetal tachycardia to sinus rhythm. In those with hydrops, the benefit over digoxin was more notable for both flecainide (OR: 5.0, 95% CI: 2.5-10.0, I 2 = 0%, P < 0.001) and sotalol (OR: 2.5, 95% CI: 1.7-5.0, I 2 = 0%, P < 0.001). When limited to atrioventricular reentrant tachycardia, flecainide was superior to digoxin (OR:1.7, 95% CI:1.1-3.3, I 2 = 62%, P = 0.03) and sotalol (OR:1.3, 95% CI:1.1-1.7, I 2 = 0%, P = 0.01).Conclusion Digoxin should not be first-line therapy for fetal tachycardia, particularly in the presence of hydrops fetalis. Flecainide should be the first-line therapy of choice in atrioventricular reentrant tachycardia. Further study may identify further sub-populations responding differently.

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Section: Methodsmentioning

confidence: 99%

Transplacental treatment of fetal tachycardia: A systematic review and meta‐analysis

et al. 2017

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“…Two other studies also report good response to flecainide as 1 st choice monotherapy, with and without hydrops [29,30]. In one, high doses (400mg/day) converted 72% of hydropic fetuses with SVT with median time of 3 days [29] whilst in the other, conversion or rate reduction was achieved in 87% using conventional doses [30]. A more aggressive approach using dual therapy (flecainide and digoxin) for all tachyarrhythmias is reported [19].…”

Section: Pharmacological Therapymentioning

confidence: 95%

“…Flecainide also converted 96% of short VA SVT compared to digoxin (69%) with shorter median response time (3 versus 8 days) [27]. Two other studies also report good response to flecainide as 1 st choice monotherapy, with and without hydrops [29,30]. In one, high doses (400mg/day) converted 72% of hydropic fetuses with SVT with median time of 3 days [29] whilst in the other, conversion or rate reduction was achieved in 87% using conventional doses [30].…”

Section: Pharmacological Therapymentioning

confidence: 99%

Fetal dysrhythmias

Carvalho

2019

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal dysrhythmias are common, usually manifesting as irregular rhythms. Whilst most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different aetiological and prognostic implications. We provide a flowchart for initial management of irregular rhythm, to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to haemodynamic compromise and may require in-utero therapy. Pharmacological treatment of tachycardia depends on type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if due to established complete heart block there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of auto-immune atrioventricular block. Sinus bradycardia (rate < 3 rd centile) may be a prenatal marker for long QT syndrome.

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“…Flecainide is an effective first-line treatment for fetal SVT with a high successful rate of 88.2%, low side effect and relatively easy utilization [33]. Flecainide is highly effective in achieving sinus rhythm in hydropic and nonhydropic fetuses with SVT, refractory SVT or SVT with signs of heart failure.…”

Section: Tachyarrhythmiasmentioning

confidence: 99%

Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics

Yuan

2020

Ital J Pediatr

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Introduction: Fetal arrhythmias are a common phenomenon with rather complicated etiologies. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias. Methods:The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed. Results: Both fetal magnetocardiogram and electrocardiogram provide information of cardiac time intervals, including the QRS and QT durations. M-mode ultrasound detects the AV and VA intervals, fetal heart rate, and AV conduction. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. Benign fetal arrhythmias, including premature contractions and sinus tachycardia, do not need any treatment before and after birth. Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Intrauterine therapy of fetal tachyarrhythmias has been carried out by the transplacental route. If maternal transplacental treatment fails, intraumbilical, intraperitoneal, or direct fetal intramuscular injection of antiarrhythmic agents can be attempted. Conclusions: The outcomes of intrauterine therapy of fetal tachyarrhythmias depend on the types or etiology of fetal arrhythmias and fetal conditions. Most are curable to a transplacental treatment by the first-line antiarrhythmic agents. Fetal cardiac pacings are effective methods to restore sinus rhythm in drug-resistant or hemodynamically compromised cases. Immediate postnatal pacemaker implantation is warranted in refractory cases.

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Flecainide as first-line treatment for fetal supraventricular tachycardia

Cited by 28 publications

References 18 publications

Transplacental treatment of fetal tachycardia: A systematic review and meta‐analysis

Transplacental treatment of fetal tachycardia: A systematic review and meta‐analysis

Fetal dysrhythmias

Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics

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