Outcomes of sustained fetal tachyarrhythmias after transplacental treatment

Bartin, Raphael; Maltret, Alice; Nicloux, M.; Ville, Y.; Bonnet, Damien; Stirnemann, J.

doi:10.1016/j.hroo.2021.02.006

Cited by 11 publications

(13 citation statements)

References 31 publications

(46 reference statements)

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“…Parents and caregivers require education on the identification and management of SVT, as well as the signs and symptoms of distress, before discharge from the hospital to improve outcomes for the infant and decrease parental anxiety (Table 4). 11,17,45,64 Many newborns with prior fetal SVT will be discharged on an antiarrhythmic, which requires additional education. Mobile cardiac telemetry at the time of discharge can be helpful for parents who are already dealing with a newborn's physical needs, medication administration, and other issues.…”

Section: Role Of the Nurse Specialist In Neonatal Arrhythmiasmentioning

confidence: 99%

Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

Batra,

Silka,

Borquez

et al. 2024

Circulation

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Disorders of the cardiac rhythm may occur in both the fetus and neonate. Because of the immature myocardium, the hemodynamic consequences of either bradyarrhythmias or tachyarrhythmias may be far more significant than in mature physiological states. Treatment options are limited in the fetus and neonate because of limited vascular access, patient size, and the significant risk/benefit ratio of any intervention. In addition, exposure of the fetus or neonate to either persistent arrhythmias or antiarrhythmic medications may have yet-to-be-determined long-term developmental consequences. This scientific statement discusses the mechanism of arrhythmias, pharmacological treatment options, and distinct aspects of pharmacokinetics for the fetus and neonate. From the available current data, subjects of apparent consistency/consensus are presented, as well as future directions for research in terms of aspects of care for which evidence has not been established.

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Section: Role Of the Nurse Specialist In Neonatal Arrhythmiasmentioning

confidence: 99%

Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

Batra,

Silka,

Borquez

et al. 2024

Circulation

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“…Studies have reported that AF patients need a longer treatment duration to convert to sinus rhythm, but once cardioversion is achieved, it is not easy to relapse [10][11]. In this case, the patient was treated with oral digoxin for 22 days.…”

Section: Discussionmentioning

confidence: 97%

Intrauterine treatment and outcome of fetal persistent atrial flutter: a case report

Runxuan

Wang

Yuewen

et al. 2022

Preprint

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Background: Fetal atrial flutter (AF) accounts for 30% of all fetal tachyarrhythmias, and more than 80% of fetal atrial flutter is 2:1 atrioventricular conduction. When a severe persistent arrhythmia occurs, intrauterine therapy is the first choice, and childbirth is not the first choice. Case presentation: A 32-year-old Chinese multipara at 30+2 weeks of gestation whose ultrasonographic examination revealed fetal persistent atrial flutter (atrial rate 219-445 beats/min, ventricular rate 219-228 beats/min, 2:1 or 1:1 down transmission) and a small amount of ascites. The fetal heart rhythm did not recover even after oral administration of digoxin and sotalol to the gravida. At 32+3 weeks of gestation, the fetal intramuscular injection of celanide was administered under the guidance of ultrasound. The fetal ventricular rate decreased 6 days after operation and the ascites disappeared. At 33+3 weeks, due to the poor tolerance of the gravida to the drugs, the infant was delivered by cesarean section. 5 minutes after birth, the infant heart rhythm was spontaneously converted to sinus rhythm. Follow-up to 1 year after birth, the infant hasn't had atrial flutter. Conclusions: In this case, the fetal heart rhythm automatically reverted to sinus rhythm after birth which appears that when the transplacental drug treatment failed, intrauterine treatment of the drug should be considered. And the prognosis of fetal atrial flutter is optimistic.

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“…Research has reported that patients with AF need a longer treatment duration to convert to sinus rhythm. However, once cardioversion is achieved, relapses are not frequent (Bartin et al, 2021; Lisowski et al, 2000). An interesting case report shared the experience of two preterm babies with AF associated with maternal opiate abuse.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine management and outcomes of persistent fetal atrial flutter: A case report

Wang

Dong

et al. 2023

Birth Defects Research

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BackgroundFetal atrial flutter (AF), accounting for 30% of all fetal tachyarrhythmias, predominantly (over 80%) manifests as a 2:1 atrioventricular conduction. Swift referral and timely intervention become imperative in instances of severe persistent arrhythmia.Case PresentationWe discuss the case of a 32‐year‐old multiparous Chinese woman, at 30+2 weeks of gestation, wherein an ultrasonographic examination revealed persistent fetal AF (atrial rate ranging from 219 to 445 beats/min and ventricular rate from 219 to 228 beats/min, with a 2:1 or 1:1 down transmission) and minor ascites. Despite the maternal ingestion of digoxin and sotalol, the fetal heart rhythm remained uncorrected. Following this, at 32+3 weeks of gestation, an intramuscular injection of cedilanid, guided by ultrasound, was administered to the fetus. Postoperatively, the fetal ventricular rate demonstrated a decline after 6 days, and the ascites resolved. Subsequently, at 33+3 weeks, a cesarean section was necessitated due to maternal intolerance to the medication, resulting in the delivery of the infant. Remarkably, the infant's cardiac rhythm spontaneously converted to sinus rhythm within 5 min of birth. A follow‐up conducted 1 year postpartum revealed no recurrence of AF.ConclusionsThis case illustrates that in the event of transplacental drug treatment failure, intrauterine therapeutic intervention should be considered. Moreover, it highlights the encouraging prognosis associated with fetal AF, as the cardiac rhythm spontaneously reverted to sinus rhythm postbirth in this instance.

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Outcomes of sustained fetal tachyarrhythmias after transplacental treatment

Cited by 11 publications

References 31 publications

Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association

Intrauterine treatment and outcome of fetal persistent atrial flutter: a case report

Intrauterine management and outcomes of persistent fetal atrial flutter: A case report

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