Second-line treatment of fetal supraventricular tachycardia using flecainide acetate.
Digoxin has been an effective treatment for fetal supraventricular tachycardia (SVT), but second-line therapy remains more controversial. Thirty-seven cases of fetal SVT were identified that received digoxin as first-line therapy. Seventeen fetuses (46%) converted to and maintained normal sinus rhythm. Flecainide was used in 13/15 patients requiring second-line therapy; 12/13 (92%) converted to sinus rhythm. Of seven hydropic fetuses, five required second-line therapy and were then successfully converted with flecainide. The improved efficacy of flecainide was statistically significant with a p value <0.01. Complete follow-up was available in 13 digoxin-treated and in 12 second-line therapy infants. Prolonged or multiple drug therapy for postnatal arrhythmia management was required in 3/13 (23%) patients in the digoxin group and in 8/12 (67%) patients requiring second-line therapy. This demonstrated a correlation between the need for second-line fetal therapy and more complex postnatal management with a p value of 0.003. Digoxin remains an effective first-line therapy in the treatment of fetal SVT. Flecainide is an effective second-line therapy, especially in the face of fetal hydrops. Use of second-line therapy in fetal SVT is a predictor of complex postnatal course, and these patients should be followed more closely.
Ebenroth
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Department of Pediatrics, Section of Pediatric Cardiology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Riley Research 104, 702 Barnhill Drive, Indianapolis, IN 46202-5225, USA. eebenrot@iupui.edu
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Darragh
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D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D005424:Flecainide / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D005424:Flecainide