Successful Treatment of Fetal Tachycardia by Sotalol

Abstract

Fetal tachyarrhythmia is one of the main reasons of referral to fetal cardiology clinic [1], because it might be associated with different forms of complex congenital heart disease [2,3] and also cause high antenatal mortality and morbidity due to heart failure [4,5]. There are is different protocols of medical therapy with variable clinical results [6]. We are reporting a successful management of 2 cases of fetal tachycardia with heart failure signs who responded dramatically to oral Satolol.Gynaecology clinic due to fetal tachyarrhythmia with moderate amount of ascites and plural pleural effusion. The mother was investigated to rule out the secondary causes of tachyarrhythmia like hyperthyroidism, anemia, fever, electrolyte imbalance and etc which were all normal.Fetal echocardiography was done at 29 weeks gestational age which showed normal fetal heart anatomy, tachycardia with fetal heart rate 250-290 beats/ min, impaired cardiac function with moderate amount of plural effusion and ascites (Figure 1 & 2). We decided to start her on oral satolol as a trial to control the fetal tachyarrhythmia, so we sent the mother to adult cardiology clinic for routine check up before starting the medicine (Electrocardiogram, Echocardiogram, blood pressure, etc). We started her on low dose initially, 80 mg orally twice daily and she was kept as inpatient under observation.The patient tolerated the medicine very well and fetal heart rate check up was done daily for 3 days which showed no response in the heart rate so we increased the dose to 80 mg three times daily orally and we kept her under observation every 3 days as outpatient (ECG for the mother and fetal heart rate monitoring), again no response in fetal heart rate with same amount of ascites and plural effusion.After that we increased the dose to 160 mg twice daily and after 3 days from this dose the mother remains stable without any change in her ECG (QTc interval) and blood pressure and the fetal heart rate reduced dramatically to 140-150 /min. Patient was kept in same dose of Satolol (160 mg twice daily) and regular weekly follow up in fetal cardiology clinic. Case (1)30 year olds lady with 28 weeks gestational, normal pregnancy without risk factors. She was referred to fetal cardiology clinic from