Management of fetal tachyarrhythmias

Abstract

Fetal tachyarrhythmias are an important cause of fetal morbidity and mortality. The majority of fetal tachyarrhythmias are due to atrioventricular reentrant type of supraventricular tachycardia and atrial flutter. Fetal echocardiography remains the main tool of diagnosing and discerning the mechanism of tachyarrhythmia. The goals of therapy for fetal arrhythmias are to restore sinus rhythm, resolve heart failure, and postpone delivery before term. Although there is no anonymity in the approach to the drug treatment of fetal tachycardia, digoxin is the most commonly employed first-line antiarrhythmic drug for supraventricular tachycardia. In digoxin nonresponders, flecainide ( digoxin) controls tachyarrhythmia with high conversion rate. A combination of digoxin and sotalol has proved effective therapy for atrial flutter, but the proarrhythmic side effect of sotalol on the fetus has been a concern. Amiodarone has emerged as a second-line treatment after digoxin failure in nonhydropic fetuses and the most effective treatment for drug-refractory fetal tachycardia accompanied by hydrops. Both the fetus and mother should be closely monitored for the response and adverse effect of the treatment. The antiarrhythmic treatment for supraventricular tachycardia should be continued after birth and during infancy due to the high incidence of postnatal recurrence.

Fetal Conduction Abnormalities: Retrospective Analysis of 40 Cases from a South Indian Tertiary Care Centre with Management Insights and Brief Review

“…While fetal arrhythmias are typically isolated findings, around 5% of cases may also involve congenital heart diseases. 26,27 In our study, all identified tachyarrhythmias were isolated without associated SHD or tumors.…”

A Case of Fetal Tachycardia after Electroconvulsive Therapy: A Possible Effect of Maternal Hypoxia and Uterine Contractions

“…Nevertheless, it is still important to be aware of tachycardia. Tachyarrhythmias, including tachycardia, are mainly caused by maternal infection or fetal hypoxia and can be lethal despite specific treatments [16, 17]; sustained fetal tachycardia might lead to fetal heart failure, hydrops, and polyhydramnios [11].…”

Non-immune hydrops foetalis due to foetal tachyarrhythmia-management with transplacental amiodarone

“…3 If undiagnosed and untreated, foetal tachycardia may lead to low-output cardiac failure and hydrops, thereby increasing foetal morbidity and mortality. [4][5][6] Ultrasonography can diagnose both, the abnormal foetal heart rate as well as the hydrops. 5,6 However, since foetal tachyarrhythmias are amenable to transplacental as well as direct foetal pharmacologic therapy, it is essential that the pregnant woman be transferred to a tertiary care centre with facilities for foetal echocardiography and therapy.…”

“…Digoxin is the usual first-line drug while sotalol, flecainide and amiodarone have been used as second-line drugs. 3,4,9 In a review of published studies, out of 314 cases of foetal SVT, Krapp and colleagues reported digoxin to be significantly less effective in the treatment of SVT in foetuses with hydrops (24.6% success) as compared to foetuses without hydrops (65.4% success). 9 Another study on refractory cases of foetal tachycardia reported a success rate of 93% in the treatment of foetal SVT in hydropic foetuses using amiodarone.…”