Maternal complications induced by digoxin treatment of fetal tachycardia: A retrospective series of 18 cases

Moatassim, S.; Touleimat, Salma; Hazelzet, T.; Brasseur, Mathilde; Diguet, Alain; Durand, Isabelle; Verspyck, É.

doi:10.1016/j.jogoh.2017.11.013

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…ECG changes such as sinus bradycardia, first-degree block, and Mobitz I second-degree block were reported in 18.2% of women with a digoxin level greater than 2 ng/mL in a retrospective case series. 8 These abnormalities reversed after withdrawing therapy. ECG changes, like premature ventricular complexes, atrial tachycardia, accelerated junctional tachycardia, or ventricular tachycardia, may portend sudden cardiac death or ventricular fibrillation, and the goal of frequent monitoring is to recognize impending signs and symptoms of maternal toxicity.…”

Section: Digoxinmentioning

confidence: 99%

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Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know

Purkayastha

Weinreich

Fontes

et al. 2020

Cardiology in Review

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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.

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Section: Digoxinmentioning

confidence: 99%

“…1 Newer data have posited flecainide as first-line therapy. 1,7–9 A metaanalysis of retrospective observational studies reported that flecainide may be no different than digoxin in efficacy and shows no difference in the rate of maternal side effects or fetal demise. 10,11 Other options include sotalol and amiodarone.…”

Section: Treatmentmentioning

confidence: 99%

Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know

Purkayastha

Weinreich

Fontes

et al. 2020

Cardiology in Review

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Section: Introductionmentioning

confidence: 99%

“…The clinical incidence of fetal arrhythmia is between 1% and 2%, [3,5] but the incidence in pregnant women at high risk is approximately 16.6% between 21 gestational weeks and full term. Sinus tachycardias and the most common fetal arrhythmia, premature atrial contraction (PAC), are both benign arrhythmias.…”

Section: Introductionmentioning

confidence: 99%

“…[1] Surviving patients may also suffer severe neurologic deficits. [5,6] A ventricular rate < 55 bpm is now recognized to constitute a significant predictive risk factor for high mortality rate. [6] The trans-placental passage of maternal antiRo/antiLa antibodies generates passively acquired autoimmunity that may be associated with serious fetal complications, including inflammation, fibrosis, fetal auto-immune complete heart block, and calcification of the conduction system.…”

Section: Introductionmentioning

confidence: 99%

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Perinatal outcomes of intrauterine fetal arrhythmias: A 10-year retrospective cohort study

Liao

et al. 2023

Medicine

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Sustained fetal arrhythmia can produce life-threatening fetal distress, fetal hemodynamic compromise, hydrops fetalis, or even fetal death. Survivors may subsequently possess severe neurologic deficits. We conducted a retrospective observational study of pregnant women hospitalized with fetal arrhythmias from January 2011 to May 2020 at West China Second University Hospital, and fetal arrhythmias were diagnosed by specialists in cardiac ultrasonography. Of 90 cases of fetal arrhythmias, 14 (15.6%) were complicated by fetal congenital heart disease (CHD), 21 (23.33%) by fetal-hydrops, 15 (16.67%) cases by intrauterine therapy, and 6 (6.67%) by maternal auto-immune disease. In the fetal-hydrops group, the intrauterine therapy rate was significantly higher (47.62% vs 7.24%, P < .001) and the survival rate significantly lower (47.62% vs 92.75%, P < .001) than in the nonfetal hydrops group. A fetus whose arrhythmia was complicated by fetal-hydrops and CHD was delivered earlier and exhibited a lower cardiovascular profile score at diagnosis and birth, lower birth weight, and a higher rate of pregnancy termination than cases without hydrops and CHD (P < .05). Among the cases with maternal auto-immune disease, 71.43% (5/7) manifested fetal atrioventricular block. Multiple linear regression analysis revealed that 3 variables -fetal-hydrops (P < .001), body mass index (P = .014), and gestational age at diagnosis of fetal arrhythmia (P = .047) -were correlated with the gestational delivery age of arrhythmic fetuses. Parents should be counseled by the multidisciplinary team regarding the individualized management and prognosis of the arrhythmic fetus, and individualized fetal intrauterine therapy should be performed if necessary.Abbreviations: AF = atrial flutter, ASD = atrial septal defect, AVB = atrioventricular block, BMI = body mass index, CHD = congenital heart disease, CVPS = cardiovascular profile score, DCDA = dichorionic diamniotic, DCDA twin = dichorionic diamniotic twin, PAC = premature atrial contraction, SVT = supraventricular tachycardia, TOP = termination of pregnancy, VSD = ventricular septal defect.

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Digoxin/sotalol

2018

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Maternal complications induced by digoxin treatment of fetal tachycardia: A retrospective series of 18 cases

Cited by 8 publications

References 11 publications

Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know

Fetal Supraventricular Tachycardia: What the Adult Cardiologist Needs to Know

Perinatal outcomes of intrauterine fetal arrhythmias: A 10-year retrospective cohort study

Digoxin/sotalol

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