Successful Digoxin Therapy of Fetal Supraventricular Tachycardia

Transplacental digoxin therapy for treatment of fetal supraventricular tachycardia

“…Supraventricular tachycardia (SVT) along with atrial flutter (AF) are the most common types of sustained fetal tachycardia. Excessive Caffeine, smoking, illicit drugs usage, fetal cardiac malformation and extracardiac malformations like diaphragmatic hernia may contribute to frequent fetal premature atrial contractions which may progress to tachyarrhythmia [10]. Our patient did not have any of these.…”

“…The fetus had no obvious structural abnormality following in utero ultrasound assessment or physical examination after birth. Various mechanisms for occurrence of SVT have been described as atrioventricular (AV) reentrant, intraatrial reentrant and AV nodal reentrant [3,10,11]. In a study by Ko et al, these three types of SVTs accounted for 73%, 14% and 13% of the cases [11].…”

“…Important considerations during treatment includes gestational age, mechanism of arrhythmias, FHR and risk of prematurity and degree of compromise (usually the presence of hydrops) [2,10]. In the term fetus, or preterm fetus in which fetal lung maturity can be demonstrated (usually > 34 weeks of gestation) urgent delivery and direct therapy are provided to the newborn [10]. Vaginal delivery can be considered if the fetus is non hydropic.…”

“…When using digoxin, maternal serum level of digoxin should be monitored to avoid toxicity, which can present as nausea, vomiting and blurring of vision [2]. Despite its effectiveness in the treatment of fetal SVT, amiodarone is usually reserved for refractory cases because of its unfavourable neonatal side effect profile (notably neonatal hypothyroidism) and the need for careful maternal monitoring [5,10]. In such refractory cases where conversion to sinus rhythm is not achieved with several maternally administered antiarrhythmic drugs, direct fetal therapy can be considered [10].…”

“…Despite its effectiveness in the treatment of fetal SVT, amiodarone is usually reserved for refractory cases because of its unfavourable neonatal side effect profile (notably neonatal hypothyroidism) and the need for careful maternal monitoring [5,10]. In such refractory cases where conversion to sinus rhythm is not achieved with several maternally administered antiarrhythmic drugs, direct fetal therapy can be considered [10]. These include intravascular, intraumbilical, intra-amniotic, intraperitoneal, intramuscular and intracardiac treatment of the fetus [4].…”