Supraventricular tachyarrhythmias: Their evaluation and therapy

Keefe, Deborah L.; Miura, Dennis S.; Somberg, John C.

doi:10.1016/0002-8703(86)90020-7

Cited by 16 publications

(2 citation statements)

References 87 publications

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“…Changes of blood flow rate and disturbances of diffusion in NIHF and placental hydrops could be the cause [9], Based on these experiences, direct appli cations of antiarrhythmic drugs are neces sary in fetuses with severe hydrops caused by tachyarrhythmia when hampered transpla cental passage is proven by fetal blood sam plings. For umbilical vein injection, amioda rone seems to be the drug of choice for the following reasons: (a) direct fetal 'loading' and reduction of the number of umbilical vein injections are possible because of the extremely long elimination half-life of amio darone; (b) amiodarone has a minor nega tive-inotropic effect compared with other antiarrhythmic agents [10], in particular ve rapamil; (c) amiodarone is highly effective in SVT [11], and (d) up to now, no important adverse effects of amiodarone treatment during pregnancy have been observed in in fants and mothers [8,12]. In cases with severe NIHF, negative inotropic agents can have deleterious effects as shown for vera pamil in 2 cases in this series and in infants with tachyarrhythmias [ 13].…”

Section: Discussionmentioning

confidence: 99%

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Gembruch

Hansmann²,

Bald³

1988

Fetal Diagn Ther

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In cases of non-immune hydrops fetalis caused by tachyarrhythmias, the transplacental passage of antiarrhythmic drugs may be hampered. When this is proven by fetal blood sampling in cases of tachyarrhythmia refractory to transplacental treatment, additional administration of antiarrhythmic drugs into the fetus is necessary and seems to improve the results. Although injections of antiarrhythmic agents in fetal ascites are also highly effective, intravascular administration by sonographic guidance is to be preferred. Then, simultaneous measurements of fetal and maternal drug levels are possible for the evaluation of pharmacokinetics and for monitoring the antiarrhythmic therapy.

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Section: Discussionmentioning

confidence: 99%

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Gembruch

Hansmann²,

Bald³

1988

Fetal Diagn Ther

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“…Amiodaron wurde bei therapierefraktärem Hydrops fetalis direkt in die Umbilicalvene verabreicht [7]. Die Vorteile des Amiodarons bestehen in der hohen Effektivität bei SVT [22,23]. Gelegentlich führt Amiodaron jedoch zu fetalem Hypothyreoidismus, der bereits intrauterin einen negativen Effekt auf die geistige Entwicklung haben kann [24].…”

Section: Diskussionunclassified

Kombinationstherapie einer fetalen supraventrikulären Tachykardie mit Flecainid und Digoxin

Anderer

Hellmeyer²,

Tekesin³

et al. 2005

Z Geburtshilfe Neonatol

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Persistent fetal supraventricular tachycardia (SVT) with more than 210 bpm frequently leads to congestive heart failure. We report on a case with SVT and congestive heart failure that converted into sinus rhythm within 19 days of therapy with flecainide and beta-acetyldigoxin. A 32-year-old II gravida I para (25 + 1 weeks of gestation) presented with fetal SVT of 267 bpm. A non-immunologic hydrops fetalis was diagnosed by ultrasound showing ascites, pleural and pericardial effusion and tricuspid regurgitation. Within 19 days of combination therapy with flecainide and digoxin, cardioversion was achieved. After 36 days of therapy no more signs of cardiac failure could be detected. A healthy boy was born at 38 + 6 weeks of gestation. Although cardioversion is expected after 72 h of therapy according to the literature, this fetus converted into sinus rhythm on day 19 of therapy. This indicates that patients should not be considered resistant to treatment within the first 3 - 4 days.

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Clinical Decision Analysis Modeling: Short‐Term Control of Ventricular Response Rate in Atrial Fibrillation or Atrial Flutter—Digoxin versus Diltiazem

Gonzalez,

Ornato,

Lawson

1994

Pharmacotherapy

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Objective. To develop a clinical decision model to compare the outcome of therapy with digoxin versus diltiazem for short‐term control of ventricular response rate (VRR) in patients with atrial fibrillation or atrial flutter.Design. Review of data from two studies that examined the percentages of response and frequency of adverse reactions in patients treated with intravenous digoxin or diltiazem to control VRR in atrial fibrillation or flutter. We constructed a clinical decision model and performed sensitivity analysis to determine if the model's predictions could be altered.Setting. Large teaching, university hospitals.Participants. Adults age 18 years or older treated with intravenous digoxin or intravenous diltiazem for atrial fibrillation or flutter (VRR > 120 beats/min). Patients with severe heart failure New York Heart Association class III or IV, a surgical procedure prior to the exacerbation, or an acute myocardial infarction were excluded.Measurements and Main Results. We measured VRR control after 1 and 24 hours of therapy (VRR < 100 beats/min or decrease of ≥ 20%) and assessed the likelihood that a patient would suffer an adverse drug reaction. Initial assumptions were that the probability digoxin would achieve VRR control was 0.10 (95% confidence interval 0.04–0.20) at 1 hour and 0.70 (95% CI 0.56–0.80) at 24 hours; the probability that diltiazem would achieve VRR control was 0.94 (95% CI 0.82–0.99) at 1 hour and 0.83 (95% CI 0.68–0.94) at 24 hours; and the probability of no serious adverse drug reaction would be 0.90 (95% CI 0.80–0.96) for digoxin and 0.96 (95% CI 0.86–0.98) for diltiazem.Results. Diltiazem was superior to digoxin with respect to the composite end point score at 1 hour (91.20 vs 17.29) and 24 hours (81.65 vs 66.43). Digoxin was superior to diltiazem at 24 hours only if the VRR was assumed to be at the highest 95% CI limit for digoxin and simultaneously at the lowest 95% CI for diltiazem (74.62 vs 68.63).Conclusions. Clinical decision analysis suggests that intravenous diltiazem is superior to intravenous digoxin in controlling VRR in patients with atrial fibrillation or flutter.

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Supraventricular tachyarrhythmias: Their evaluation and therapy

Cited by 16 publications

References 87 publications

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Direct Intrauterine Fetal Treatment of Fetal Tachyarrhythmia with Severe Hydrops fetalis by Antiarrhythmic Drugs

Kombinationstherapie einer fetalen supraventrikulären Tachykardie mit Flecainid und Digoxin

Clinical Decision Analysis Modeling: Short‐Term Control of Ventricular Response Rate in Atrial Fibrillation or Atrial Flutter—Digoxin versus Diltiazem

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