Foetal supraventricular tachycardia treated with sotalol

Abstract

Sonesson S‐E, Fouron J‐C, Wesslen‐Eriksson E, Jaeggi E, Winberg P. Foetal supraventricular tachycardia treated with sotalol. Acta Pædiatr 1998; 87: 584‐7. Stockholm. ISSN 0803‐5253 This retrospective study (1991‐95) presents our experience with sotalol in the treatment of 14 foetuses with supraventricular tachycardia (SVT). SVT was diagnosed in a structurally normal heart at a gestational age of 24‐35 (median 28) weeks. In eight foetuses, hydrops was evident at presentation. In all patients pharmacological conversion with digoxin was tried before sotalol treatment was started. Sotalol was given orally to the mothers in a dose of 80–160 mg x2. Cardioversion was obtained in 10 foetuses. In seven of these patients re‐entry tachycardia and in five pre‐excitation could be documented after birth. In two foetuses not responding to sotalol a long RP tachycardia was demonstrated; even when using digoxin, sotalol, flecainide and/or propafenone in different combinations after birth complete suppression of the arrhythmia was not obtained. Two severely hydropic foetuses died 1 and 10 d, respectively, after starting with sotalol. The 12 surviving infants were doing well except for one infant, with a cerebral lesion probably related to the arrhythmia. These findings demonstrate that sotalol can be useful in the treatment of foetal SVT.

Comparison of Transplacental Treatment of Fetal Supraventricular Tachyarrhythmias With Digoxin, Flecainide, and Sotalol

“…24 When these drugs were used as first choice, termination of AF/SVT before birth occurred in 51% of fetuses (115 of 226) with digoxin, 6 -9,13,14,19,20,25 in 64% (45 of 70) with flecainide, 4,6 -8,16 and in 66% (23 of 35) with sotalol. 10,12,15,19 This implies that sotalol and flecainide may be the most effective drugs regardless of the underlying arrhythmia mechanism. Nevertheless, clinically more relevant than rates of arrhythmia termination at birth is the response time to a particular intervention, and this information is available only for digoxin in 1 study.…”

Effectiveness of Sotalol as First-Line Therapy for Fetal Supraventricular Tachyarrhythmias

“…Sotalol has been used as a second-line agent to treat fetal supraventricular tachycardia (SVT) with mixed results. [1][2][3][4][5] In 2000, Oudijk et al 2 reported discouraging results with sotalol in the treatment of fetal SVT because of the high fetal mortality associated with treatment. However, 3 of the 4 nonsurviving fetuses were grossly hydropic at presentation, a factor that likely contributed to their death.…”

Prenatal management with digoxin and sotalol combination for fetal supraventricular tachycardia : Case report and review of literature

“…[9] Sotalol, a beta adrenergic antagonist, has been recently introduced in the treatment of SVT in fetuses with and without fetal hydrops. [4] Potential pro-arrhythmic effects of sotalol remain a source of concern, which excludes it as the drug of Þ rst choice in uncomplicated SVT. In cases with severe hydrops and poor cardiac function, due to its possible negative inotropic effect, the drug should always be administered in association with digoxin.…”

“…[2,3] Other agents such as flecainide and sotalol have been tried as first-line agents but with adverse events. [3,4] We report a case of fetal supraventricular tachyarrhythmia with hydrops detected at 32 weeks and managed with combination of oral digoxin and sotalol.…”