Prenatal ultrasound may predict fetal response to therapy in non-hydropic fetuses with supraventricular tachycardia.
OBJECTIVE
To study the fetal response to prenatal therapy in non-hydropic fetuses with supraventricular tachycardia (SVT) as a function of fetal haemodynamic status at presentation.


METHODS
Retrospective study.


METHODS
Between 1990 and 2000, 40 non-hydropic fetuses presented with SVT. Twenty-eight had reciprocating SVT and 12 had atrial flutter. Ten fetuses had significant tricuspid valve regurgitation. All fetuses were treated prenatally. The main outcome measurement was fetal response to therapy as assessed by the rate of prenatal SVT reduction and by the mean time interval to sinus rhythm restoration.


RESULTS
The mean gestational age at presentation was 29 +/- 4.9 weeks. Overall, there were 39 live births and 1 intrauterine death. Reduction of SVT was achieved prenatally in 32 cases (80%). Among the 30 cases without tricuspid regurgitation, prenatal conversion to sinus rhythm was achieved in 27 cases (90%) with a mean time interval of 7 days. Among the 10 fetuses presenting with tricuspid regurgitation, the rate of prenatal conversion was significantly lower (5/10) and the mean time interval to conversion was significantly longer (24 days; p = 0.04, Mann-Whitney test). In the subgroup treated by digoxin as first-line therapy (n = 32), the interval to sinus rhythm restoration was also significantly higher in the presence of tricuspid regurgitation, with a slightly but not significantly lower reduction rate.


CONCLUSIONS
The response to prenatal therapy may be poorer in cases presenting with tricuspid regurgitation.
Jouannic
J M
JM
Maternité, Hôpital Necker-Enfants-Malades, Faculté de Médecine Paris-V, France. jean-marie.jounnic@nck.ap-hop-paris.fr
Le Bidois
J
J
Fermont
L
L
Villain
E
E
Mahieu-Caputo
D
D
Dumez
Y
Y
Dommergues
M
M
D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D013015:Sotalol / Q000627:therapeutic use; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000188:drug therapy; D016216:Ultrasonography, Prenatal
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol; D000638:Amiodarone