Second-Line Treatment of Fetal Supraventricular Tachycardia Using Flecainide Acetate

Ebenroth, Eric S.; Cordes, Timothy M.; Darragh, Robert K.

doi:10.1007/s002460010279

Cited by 49 publications

(34 citation statements)

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“…5,16 Flecainide has been shown to be effective in controlling tachycardia and leading to the resolution of hydrops in this population, with conversion rates Ͼ80% reported in several small series either with flecainide as a first-line or secondline agent after digoxin therapy. 14,15,17,18 The interval to conversion to sinus rhythm that we observed for sotalol is similar to that suggested in the published data for flecainide. Allan et al 17 reported conversion by 48 hours after the initiation of flecainide in most patients (9 of 12); however, Krapp et al 15 later demonstrated a 5-day mean (range 0 to 14) interval to conversion after flecainide was initiated in a group of 19 patients already being treated with digoxin.…”

Section: Discussionsupporting

confidence: 78%

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

Shah

Moon-Grady

Bhogal

et al. 2012

The American Journal of Cardiology

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Section: Discussionsupporting

confidence: 78%

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

Shah

Moon-Grady

Bhogal

et al. 2012

The American Journal of Cardiology

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“…Most drugs, with the exception of sotalol and flecainide, have diminished transplacental transfer with fetal hydrops. 464 These 2 drugs concentrate in the amniotic fluid in greater concentrations than in the fetus. 464 Neonatal conduction abnormalities have been reported with flecainide.…”

Section: Arrhythmia Medicationsmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

976

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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“…4 -18 Nonetheless, in the absence of comparative drug studies, the optimal treatment remains contentious. Digoxin is the most often used first-line antiarrhythmic drug, 5,6,8,9,13,14 albeit its efficacy in controlling fetal SVT within a reasonable time frame has been questioned. 7 Others have suggested that flecainide and sotalol are more effective in terminating AF and SVT 4,6 -8,12,15 ; however, rare reports of unexplained fetal deaths have raised concerns that flecainide and sotalol may provoke fatal proarrhythmia, although there has been no objective evidence to support such concerns.…”

Section: Editorial See P 1703 Clinical Perspective On P 1754mentioning

confidence: 99%

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

et al. 2011

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Background-Fetal tachyarrhythmia may result in low cardiac output and death. Consequently, antiarrhythmic treatment is offered in most affected pregnancies. We compared 3 drugs commonly used to control supraventricular tachycardia (SVT) and atrial flutter (AF). Methods and Results-We reviewed 159 consecutive referrals with fetal SVT (nϭ114) and AF (nϭ45). Of these, 75 fetuses with SVT and 36 with AF were treated nonrandomly with transplacental flecainide (nϭ35), sotalol (nϭ52), or digoxin (nϭ24) as a first-line agent. Prenatal treatment failure was associated with an incessant versus intermittent arrhythmia pattern (nϭ85; hazard ratio [HR]ϭ3.1; PϽ0.001) and, for SVT, with fetal hydrops (nϭ28; HRϭ1.8; Pϭ0.04). Atrial flutter had a lower rate of conversion to sinus rhythm before delivery than SVT (HRϭ2.0; Pϭ0.005).Cardioversion at 5 and 10 days occurred in 50% and 63% of treated SVT cases, respectively, but in only 25% and 41% of treated AF cases. Sotalol was associated with higher rates of prenatal AF termination than digoxin (HRϭ5.4; Pϭ0.05) or flecainide (HRϭ7.4; Pϭ0.03). If incessant AF/SVT persisted to day 5 (nϭ45), median ventricular rates declined more with flecainide (Ϫ22%) and digoxin (Ϫ13%) than with sotalol (Ϫ5%; PϽ0.001). Flecainide (HRϭ2.1; Pϭ0.02) and digoxin (HRϭ2.9; Pϭ0.01) were also associated with a higher rate of conversion of fetal SVT to a normal rhythm over time. No serious drug-related adverse events were observed, but arrhythmia-related mortality was 5%. Conclusion-Flecainide and digoxin were superior to sotalol in converting SVT to a normal rhythm and in slowing both AF and SVT to better-tolerated ventricular rates and therefore might be considered first to treat significant fetal tachyarrhythmia. (Circulation. 2011;124:1747-1754.)

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Second-Line Treatment of Fetal Supraventricular Tachycardia Using Flecainide Acetate

Cited by 49 publications

References 0 publications

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

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

Diagnosis and Treatment of Fetal Cardiac Disease

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

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