Foetal supraventricular tachycardia with hydrops fetalis: a role for direct intraperitoneal amiodarone

Kang, Sok‐Leng; Howe, David; Coleman, Matthew A.; Roman, Kevin S.; Gnanapragasam, James

doi:10.1017/s104795111400002x

Cited by 10 publications

(14 citation statements)

References 34 publications

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“…Besides, immediate cardioversion was also observed in a fetus receiving intraumbilical injection of amiodarone. Hydrops fetalis resolved in 62.5% (5/8) fetuses, with a mean resolution time of 28.4 days [42].…”

Section: Tachyarrhythmiasmentioning

confidence: 99%

Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics

Yuan

2020

Ital J Pediatr

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Introduction: Fetal arrhythmias are a common phenomenon with rather complicated etiologies. Debates remain regarding prenatal diagnosis and treatment of fetal arrhythmias. Methods:The literature reporting on prenatal diagnosis and treatment of fetal arrhythmias published in the recent two decades were retrieved, collected and analyzed. Results: Both fetal magnetocardiogram and electrocardiogram provide information of cardiac time intervals, including the QRS and QT durations. M-mode ultrasound detects the AV and VA intervals, fetal heart rate, and AV conduction. By using Doppler ultrasound, simultaneous recording of the atrial and ventricular waves can be obtained. Benign fetal arrhythmias, including premature contractions and sinus tachycardia, do not need any treatment before and after birth. Sustained fetal arrhythmias that predispose to the occurrence of hydrops fetalis, cardiac dysfunction or eventual fetal demise require active treatments. Intrauterine therapy of fetal tachyarrhythmias has been carried out by the transplacental route. If maternal transplacental treatment fails, intraumbilical, intraperitoneal, or direct fetal intramuscular injection of antiarrhythmic agents can be attempted. Conclusions: The outcomes of intrauterine therapy of fetal tachyarrhythmias depend on the types or etiology of fetal arrhythmias and fetal conditions. Most are curable to a transplacental treatment by the first-line antiarrhythmic agents. Fetal cardiac pacings are effective methods to restore sinus rhythm in drug-resistant or hemodynamically compromised cases. Immediate postnatal pacemaker implantation is warranted in refractory cases.

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Section: Tachyarrhythmiasmentioning

confidence: 99%

Fetal arrhythmias: prenatal evaluation and intrauterine therapeutics

Yuan

2020

Ital J Pediatr

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“…Digoxin and amiodarone are the preferred drugs. Dose is based on fetal weight, but a 25% increase is recommended to account for placental circulation [25].…”

Section: Pharmacological Therapymentioning

confidence: 99%

“…Amiodarone is considered as 2 nd -line option in drug-refractory tachycardia with hydrops. It was successfully injected to the umbilical vein nearly three decades ago [32] and is still considered safe [25]. Intramuscular fetal…”

Section: Pharmacological Therapymentioning

confidence: 99%

Fetal dysrhythmias

Carvalho

2019

Best Practice & Research Clinical Obstetrics & Gynaecol

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Fetal dysrhythmias are common, usually manifesting as irregular rhythms. Whilst most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different aetiological and prognostic implications. We provide a flowchart for initial management of irregular rhythm, to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to haemodynamic compromise and may require in-utero therapy. Pharmacological treatment of tachycardia depends on type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if due to established complete heart block there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of auto-immune atrioventricular block. Sinus bradycardia (rate < 3 rd centile) may be a prenatal marker for long QT syndrome.

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“…If there is no therapeutic response in fetuses who are severely affected, the third-choice drug, amiodarone, may be used at a dose of 800-1,200 mg/day. 178-179 This drug, however, has a significant toxicity for both mother and fetus. 180…”

Section: Fetal Cardiac Arrhythmias: Diagnosis and Treatmentmentioning

confidence: 99%