Adenosine Triphosphate for Cardioversion of Supraventricular Tachycardia in Two Hydropic Fetuses

Abstract

Objective: We performed a retrospective study to check the effectiveness of adenosine triphosphate (Striadyne) for cardioversion of fetal supraventricular tachycardia (SVT) and to evaluate neonatal outcome after prenatal treatment of severe SVT with fetal hydrops. Methods: Two hydropic fetuses with SVT were treated with Striadyne injection into the umbilical vein, as an additional treatment to the digoxin given intravenously to the mother. Both fetuses were in severe condition, with ultrasound, Doppler and laboratory signs of fetal distress and congestive heart failure. Results: Sinus rhythm was obtained in both cases for different periods of time, without side effects of Striadyne. The children survived. There were severe cardiac and neurologic problems after delivery. Conclusions: Striadyne was an effective drug in converting SVT to the sinus rhythm in hydropic fetuses. Digoxin was useless in these fetuses in spite of the therapeutic level which was obtained in both mothers. We suppose that fetal SVT causing fetal hydrops could be the reason of brain damage, and intensive antiarrhythmic treatment seemed to be necessary.

Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia

“…Our initial search yielded 93 titles and abstracts, 19 full-text articles were retained for manual review 4,7,[13][14][15][17][18][19][20][21]38,[68][69][70][71][72][73][74][75] ( Figure 1). This represented a total of 495 cases of fetal SVT, 107 of which had hydrops fetalis.…”

“…Although some investigators specified that they performed investigations daily—including electrolytes, 17,18 ECG, 15,18,19 and drug levels 18 —most authors remained nonspecific about the frequency of testing during follow-up. 7,13,14,20,38,69,70,72–74 At a minimum, the signs and symptoms of toxicity, electrolyte abnormalities, and evidence of toxicity on ECG should be sought after initiation of treatment, at time of dose adjustment, or as indicated by clinical judgment. In the absence of resolution of the fetal SVT, doses should be increased or a new agent should replace/be added to the current treatment regimen.…”