Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy?
OBJECTIVE
The aim of this study was to evaluate the role of amiodarone for the prenatal treatment of hydropic fetuses with supraventricular tachycardia.


METHODS
A group of 26 hydropic fetuses with supraventricular tachycardia was studied retrospectively.


RESULTS
Twenty-five fetuses received transplacental treatment. The overall prenatal conversion rate was 60%. Nine fetuses were converted to sinus rhythm using either flecainide (n = 7) or amiodarone (n = 2) as first line therapy, whilst digoxin alone or in association with sotalol failed to restore sinus rhythm in all cases. After first-line therapy, supraventricular tachycardia persisted in 10 fetuses. Nine fetuses received amiodarone alone or in association with digoxin as second-line therapy, five of whom were converted to sinus rhythm. Among the 11 live neonates treated by amiodarone in utero, 2 (17%) presented an elevated thyroid stimulating hormone at day 3-4. These two infants received thyroid hormone substitution therapy and had a normal outcome.


CONCLUSIONS
When first-line therapy fails to restore sinus rhythm in hydropic fetuses with supraventricular tachycardia, amiodarone therapy should be considered as it allows a substantial number of fetuses to be converted prenatally.
Jouannic
Jean-Marie
JM
Maternité, Hôpital Necker-Enfants-Malades, Faculté de Médecine Paris V, 149 rue de Sèvres, 75015 Paris, France. jean-marie.jouannic@nck.ap-hop-paris.fr
Delahaye
Sophie
S
Fermont
Laurent
L
Le Bidois
Jérôme
J
Villain
Elisabeth
E
Dumez
Yves
Y
Dommergues
Marc
M
D000638:Amiodarone / Q000627:therapeutic use*; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005424:Flecainide / Q000627:therapeutic use; D015160:Hydrops Fetalis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D005424:Flecainide; D000638:Amiodarone