Postnatal recurrence and transesophageal inducibility of prenatally treated fetal supraventricular tachycardia

Michel, Miriam; Renaud, Claudia; Chiu‐Man, Christine; Gross, Gil J.; Jaeggi, Edgar

doi:10.1016/j.hrthm.2022.04.013

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…Maturational changes in the conduction properties of the accessory connection with advancing gestation may also explain the high conversion rate in our study. These changes are mirrored by the findings of a recent study, in which only 50% of neonates treated prenatally for short or long VA tachycardia who underwent transesophageal pacing study had inducible tachyarrhythmia 24 .…”

Section: Discussionmentioning

confidence: 57%

Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia

Holmes

Hornberger

Jaeggi

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveWhile in‐utero treatment of sustained fetal supraventricular arrhythmias (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34‐37 weeks), early term (37‐39 weeks) and term fetuses (39‐41 weeks) with SVA. We reviewed the outcomes of such fetuses undergoing treatment at multiple institutions, rather than immediate delivery.MethodsThis was a retrospective case series performed by collecting data on gestational age at presentation and delivery, SVA diagnosis, anti‐arrhythmic medications, time to sinus rhythm and postnatal SVA recurrence.ResultsThirty‐seven fetuses presented at 35‐39 (mean ± SD, 36.1 ± 1.1) weeks in short VA tachycardia (n=20), long VA tachycardia (n=7) or atrial flutter (n=10). Four fetuses (11%) were hydropic. In utero treatment led to restoration of sinus rhythm in 35 (95%) at a mean ± SD of 4.1 ± 4.6 days; this included three of the four fetuses with hydrops. Anti‐arrhythmic medications included flecainide (n=11), digoxin (n=7), sotalol (n=11), and dual therapy (n=8). All fetuses were liveborn at 36‐41 weeks via spontaneous or induced vaginal delivery (63%; n=23) or Cesarean delivery (n=14). Cesarean delivery was for fetal SVT in two fetuses, atrial ectopy, or sinus bradycardia in three fetuses, and for obstetrical reasons in nine fetuses in sinus rhythm at the time of delivery. Twenty‐one (57%) were treated for recurrent SVA after birth.ConclusionIn‐utero treatment of the near term and term (≥ 35‐week) SVA fetus is highly successful (95%) even in the presence of hydrops, with the majority delivered vaginally closer to term, hence avoiding unnecessary Cesarean sections.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 57%

Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia

Holmes

Hornberger

Jaeggi

et al. 2023

Ultrasound in Obstet & Gyne

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“…For the fetus, third‐trimester biophysical profiles or non‐stress‐testing assessments are indicated. Generally, if good control of the rhythm has been achieved, as is the case in about 75% to 90% of cases, vaginal delivery is possible 31 . The infant should be monitored in a neonatal intensive care unit (ICU) setting during the withdrawal phase from medication, and if SVT or AFl has not recurred during the first 72 hours, home heart rate monitoring or transesophageal electrophysiologic study can be considered 31 …”

Section: Treatment Of Fetal Tachyarrhythmiamentioning

confidence: 99%

“…By delivering the infant prematurely, the effective drug processing power of the placenta and maternal circulation is exchanged for the immature drug processing of the premature infant's liver and kidneys 35 . At least 40% to 60% of infants will require neonatal drug treatment 31 ; therefore, having a mature neonate delivered in sinus rhythm is a marked advantage. The need for transfusions for anemia from bone marrow suppression, exchange transfusions for hyperbilirubinemia due to drug displacement of bilirubin‐binding sites, and prolonged neonatal ICU care for regulating drug therapy are much higher for the premature infant.…”

Section: Treatment Of Fetal Tachyarrhythmiamentioning

confidence: 99%

“…31 The infant should be monitored in a neonatal intensive care unit (ICU) setting during the withdrawal phase from medication, and if SVT or AFl has not recurred during the first 72 hours, home heart rate monitoring or transesophageal electrophysiologic study can be considered. 31 Mechanisms of Fetal Tachycardia and the Drugs That Are Used to Treat These Reentrant SVT. The vast majority of fetal SVT is reentrant SVT.…”

Section: Impact Of Fetal Tachycardia Treatment On Maternal and Child ...mentioning

confidence: 99%

“…Drugs to Treat Fetal SVT and Atrial Flutter a Drug2,6,12,25,27,28,31,[74][75][76][77][78][79][80][81][82][83][84] Type of Arrhythmia F:M Drug RatioRoute…”

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confidence: 99%

See 2 more Smart Citations

Fetal Arrhythmia Diagnosis and Pharmacologic Management

Strasburger

Eckstein

Butler

et al. 2022

The Journal of Clinical Pharma

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One of the most successful achievements of fetal intervention is the pharmacologic management of fetal arrhythmias. This management usually takes place during the second or third trimester. While most arrhythmias in the fetus are benign, both tachy-and bradyarrhythmias can lead to fetal hydrops or cardiac dysfunction and require treatment under certain conditions. This review will highlight precise diagnosis by fetal echocardiography and magnetocardiography, the 2 primary means of diagnosing fetuses with arrhythmia. Additionally, transient or hidden arrhythmias such as bundle branch block, QT prolongation, and torsades de pointes, which can lead to cardiomyopathy and sudden unexplained death in the fetus, may also need pharmacologic treatment. The review will address the types of drug therapies; current knowledge of drug usage, efficacy, and precautions; and the transition to neonatal treatments when indicated. Finally, we will highlight new assessments, including the role of the nurse in the care of fetal arrhythmias. The prognosis for the human fetus with arrhythmias continues to improve as we expand our ability to provide intensive care unit-like monitoring, to better understand drug treatments, to optimize subsequent pregnancy monitoring, to effectively predict timing for delivery, and to follow up these conditions into the neonatal period and into childhood. Coordinated initiatives that facilitate clinical fetal research are needed to address gaps in knowledge and to facilitate fetal drug and device development.

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Transesophageal pacing studies reduce readmission but prolong initial admission in infants with supraventricular tachycardia: A cost-comparison analysis

Vari¹,

Temple²,

Tadeo³

et al. 2023

Heart Rhythm O2

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Postnatal recurrence and transesophageal inducibility of prenatally treated fetal supraventricular tachycardia

Cited by 6 publications

References 21 publications

Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia

Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia

Fetal Arrhythmia Diagnosis and Pharmacologic Management

Transesophageal pacing studies reduce readmission but prolong initial admission in infants with supraventricular tachycardia: A cost-comparison analysis

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