Transplacental Cardioversion of Intrauterine Supraventricular Tachycardia With Digitalis

Kerenyi, Thomas D.; Meller, Jose; Steinfeld, Leonard; Gleicher, Norbert; Brown, Edwin G.; Chitkara, Usha; Raucher, Harold S.

doi:10.1016/s0140-6736(80)90441-9

Cited by 96 publications

(32 citation statements)

References 11 publications

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“…But placental transfer of digoxin is erratic, varying not only among the previous case reports (1-5, 7, 8) but also among studies (9-1 1). In one case report (2), the concentration of digoxin in umbilical cord blood was about one-fourth the concentration in maternal blood; in another (3), digoxin concentration in umbilical cord blood was almost the same as that in maternal blood. Furthermore, in some cases (4,8) the dose of digoxin had to be reduced to avert maternal toxicity.…”

Section: Discussionmentioning

confidence: 93%

“…One to 3 d after surgery, we studied tion to pregnant women has been successful in the treatment of the distribution of digoxin in the maternal-fetal unit. Digoxin fetal tachyarrhythmia (1)(2)(3)(4)(5)(6)(7)(8). Previous studies have demonstrated was diluted in 20 mL saline and injected into the amniotic that digoxin easily crosses the placenta in the human (9, 10) and catheter located near the cervix.…”

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confidence: 99%

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Fetal Uptake of Intraamniotic Digoxin in Sheep

et al. 1990

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ABSTRACT. To explore the possibility that intraamniotic is impractical to treat tachyarrhythmia both because multiple administration of digoxin is an effective treatment regimen intrafetal injections are required and because fetal plasma digoxin for fetal tachyarrhythmia, we injected digoxin into the concentrations are difficult to control. To determine whether amniotic fluid cavity of pregnant sheep and examined the intraamniotic administration of digoxin might effectively treat time course of digoxin distribution to the fetal and maternal fetal tachyarrhythmia, we injected digoxin into the amniotic plasma compartments. Animals were studied in two groups cavity of pregnant sheep and measured the distribution of digoxin according to digoxin dosage: 0.7-1.8 nmol/kg fetal body wt from the amniotic cavity to the fetal and maternal plasma in the high-dose group (n = 6) and 0.1-0.6 nmol/kg fetal compartments. body wt in the low-dose group (n = 14). Within 1 h, plasma digoxin concentrations in the high-dose and low-dose L, and at 24 h they were 2.3 nmol/L (n = 1) and 1.8 f 1.2 gestation. Surgical techniques to implant catheters into the ewe nmol/L, respectively. Peak maternal digoxin levels were and the fetus have been described in detail previously (14). about one-tenth fetal values in the high-dose group and Briefly, after spinal anesthesia was induced in the ewe with 4 mL undetectable in the low-dose group. Fetal digoxin concen-of 1 % tetracaine hydrochloride, polyvinyl catheters were inserted trations were significantly greater in the descending aorta into a peripheral artery and vein. The ewes were given an i.v.than in the umbilical vein ( p < 0.02). Fetal arterial blood infusion of 0.9% saline during the operative procedure. Ketamine pressure and heart rate were not significantly different was administered intravenously in doses of 100 mg every 15-20 from control at any time after digoxin administration. min. Through a midline incision, the uterus was exposed and These results demonstrate that digoxin is rapidly taken up the fetal hindlimbs identified. Polyvinyl catheters were inserted into the fetal circulation from the maternal amniotic cavity. into a peripheral artery and vein of each hindlimb and advanced The exact mechanism whereby this occurs is unknown, but to the descending aorta and inferior vena cava. In seven fetuses, transplacental transfer from the maternal circulation is not an 8 F polyvinyl catheter was inserted suprapubically into the involved. Our findings suggest that intraamniotic admin-urinary bladder through a purse-string suture (15). A 3.5 F istration of digoxin may be an alternative treatment for multiple side-hole catheter was introduced into a distal cotylefetal tachyarrhythmias when direct administration of an-donary tributary of the umbilical vein and advanced proximally tiarrhythmic agents is ineffective or produces maternal toward the fetal body in 12 animals. Two catheters were also toxicity. (Pediatu Res 27: 282-285, 1990) inserted into the amniotic cavity, one near the cervix a...

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

Fetal Uptake of Intraamniotic Digoxin in Sheep

et al. 1990

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“…In 1980 Kerenyi described treatment with digoxin in foetuses with SVT 19 , and in 1982 Kleinman published a case of a foetus with oedema caused by SVT and successful treatment with digoxin 20 . At present, it is assumed that the type of supraventricular contraction plays the most important role in the choice of anti-arrhythmia medication.…”

Section: Discussionmentioning

confidence: 99%

Review Paper. Transplacental Digoxin Treatment In Prenatal Cardiac Problems In Singleton Pregnancies - Meta Analysis (Based On Literature: 1992–2015)

Strzelecka

Respondek-Liberska

Słodki

et al. 2016

Prenatal Cardiology

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Based on fourteen case reports from various centres from 1992-2015 and three original studies in [2006][2007][2008][2009][2010][2011] 122 fetuses were subjected to analysis. In these reports, transplacental digoxin treatment was administered to different cardiac anomalies such as SVT , Ebstein's anomaly, critical AS , absent pulmonary valve syndrome, complete heart block, in foetuses with aneurysm/diverticulum of LV, in tricuspid atresia or dysplasia, rhabdomyoma, pulmonary atresia, HLHS with fibroelastosis, in TTTS and in extracardiac anomalies such as atriovenous malformation or sacrococcygeal teratoma. There was no statistical difference to suggest (Chi-square test) that digoxin was more efficient to control fetal arrhythmias than fetal congestive heart failure in nonarrhythmic patients.Conclusions: Foetal cardiac insufficiency may appear due to different reasons (in normal heart anatomy or in heart defects, in normal sinus rhythm or due to foetal arrhythmias: tachycardias or severe bradycardia) and may be a cause of intrauterine demise. So far, we do not have strong evidence that digoxin treatment may prevent foetal death or prematurity. More research is needed to ascertain if the prolonging of pregnancy resulted from digoxin treatment or if improvement in foetal circulatory insufficiency was influenced by spontaneous regression of foetal cardiac symptoms.

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“…Supraventricular tachycardia was first treated by transplacental application of digitalis in 1980 [5]. In 1988, successful prenatal application of flecainide acetate for supraventricular tachycardia was first reported by Wren and Hunter [6] and favorable results were published in a report describing 14 cases by Allan et al [7] in 1991.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Supraventricular Tachycardia Exhibiting Hydrops fetalis with Flecainide Acetate

et al. 2003

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Background: The efficacy of flecainide acetate for the treatment of fetal supraventricular tachycardia with hydrops fetalis and changes in venous blood flow patterns in the fetus during treatment are reported. Case: Oral flecainide administration was started at 30 weeks of gestation. Cardioversion was achieved 6 days after treatment. Sustained abnormal venous Doppler indices were shown and complete normalization of venous returns was observed 6 days after cardioversion. A vigorous male baby was born, and he is now 1 year of age and in good condition with no medication. Conclusion: Reversible cardiac dysfunction was observed even after cardioversion in the fetus with supraventricular tachycardia, which could be assessed precisely by venous Doppler analysis.

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Transplacental Cardioversion of Intrauterine Supraventricular Tachycardia With Digitalis

Cited by 96 publications

References 11 publications

Fetal Uptake of Intraamniotic Digoxin in Sheep

Fetal Uptake of Intraamniotic Digoxin in Sheep

Review Paper. Transplacental Digoxin Treatment In Prenatal Cardiac Problems In Singleton Pregnancies - Meta Analysis (Based On Literature: 1992–2015)

Successful Treatment of Supraventricular Tachycardia Exhibiting Hydrops fetalis with Flecainide Acetate

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