Prenatal Ultrasound May Predict Fetal Response to Therapy in Non-Hydropic Fetuses with Supraventricular Tachycardia

Abstract

Objective: To study the fetal response to prenatal therapy in non-hydropic fetuses with supraventricular tachycardia (SVT) as a function of fetal haemodynamic status at presentation. Study Design: Retrospective study. Material and Methods: Between 1990 and 2000, 40 non-hydropic fetuses presented with SVT. Twenty-eight had reciprocating SVT and 12 had atrial flutter. Ten fetuses had significant tricuspid valve regurgitation. All fetuses were treated prenatally. The main outcome measurement was fetal response to therapy as assessed by the rate of prenatal SVT reduction and by the mean time interval to sinus rhythm restoration. Results: The mean gestational age at presentation was 29 ± 4.9 weeks. Overall, there were 39 liveborns and 1 intrauterine death. Reduction of SVT was achieved prenatally in 32 cases (80%). Among the 30 cases without tricuspid regurgitation, prenatal conversion to sinus rhythm was achieved in 27 cases (90%) with a mean time interval of 7 days. Among the 10 fetuses presenting with tricuspid regurgitation, the rate of prenatal conversion was significantly lower (5/10) and the mean time interval to conversion was significantly longer (24 days; p = 0.04, Mann-Whitney test). In the subgroup treated by digoxin as first-line therapy (n = 32), the interval to sinus rhythm restoration was also significantly higher in the presence of tricuspid regurgitation, with a slightly but not significantly lower reduction rate. Conclusion: The response to prenatal therapy may be poorer in cases presenting with tricuspid regurgitation.

First‐Line Antiarrhythmic Transplacental Treatment for Fetal Tachyarrhythmia: A Systematic Review and Meta‐Analysis

“…Amiodarone was not included in the analysis given the small number of patients reported in the literature. The studies included in the meta‐analysis are summarized in Table 3 19, 20…”

“…B, Digoxin vs sotalol in termination of supraventricular tachycardia in nonhydropic fetuses 19, 24. C, Flecainide vs digoxin in termination of supraventricular tachycardia in hydropic fetuses 4, 6, 9, 21, 26.…”

“…The studies included in the meta-analysis are summarized in Table 3. 19,20 Termination of SVT and AF In patients with SVT, digoxin achieved a lower rate of SVT termination compared with flecainide (odds ratio [OR]: 0.773; 95% confidence interval [CI], 0.605-0.987;…”

“…A, Digoxin vs flecainide in termination of supraventricular tachycardia in nonhydropic fetuses.4,6,21,24 B, Digoxin vs sotalol in termination of supraventricular tachycardia in nonhydropic fetuses 19,24. C, Flecainide vs digoxin in termination of supraventricular tachycardia in hydropic fetuses.4,6,9,21,26 CI indicates confidence interval; RR, relative risk.…”

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

“…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 ) …”