Fetal supraventricular tachycardia diagnosed and treated at twenty-four weeks of gestation and after birth: a case report.
Supraventricular tachycardia is the most common clinically significant fetal tachycardia. The diagnosis is usually made at routine sonographic workup during the second-third trimester of pregnancy. Treatment goals are cardioversion to sinus rhythm and reversal of cardiac dysfunction. We describe a case of fetal supraventricular tachycardia diagnosed at 24 weeks of gestation. The first-line treatment was oral maternal digoxin and sotalol. This therapy was not sufficient for complete control of the tachycardia. Hence, second-line treatment with digoxin and flecainide was started and successfully achieved conversion to sinus rhythm. No adverse maternal side effects were noted during the 14 weeks of therapy. A normal male infant was delivered at elective cesarean section performed for obstetric indications at 38 weeks of gestation. A persistent junctional reciprocating tachycardia with a ventriculo-atrial/atrioventricular ratio > 1 was diagnosed following delivery at transesophageal electrophysiological study. At the age of 8 months the child is on therapy with sotalol (4 mg/kg/day) and flecainide (3 mg/kg/day) and is in good clinical conditions.
Romeo
Emanuele
E
Chair of Cardiology, Second University of Naples, Italy. ema.romeo@virgilio.it
D'Alto
Michele
M
Russo
Maria Giovanna
MG
Sarubbi
Berardo
B
Cardaropoli
Dominga
D
Paladini
Dario
D
Pacileo
Giuseppe
G
Annunziata
Annalisa
A
Calabrò
Raffaele
R
D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004077:Digoxin / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005316:Fetal Distress / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005424:Flecainide / Q000008:administration & dosage / Q000627:therapeutic use; D005865:Gestational Age; D006801:Humans; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D013015:Sotalol / Q000008:administration & dosage / Q000627:therapeutic use; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D016216:Ultrasonography, Prenatal
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol; D005424:Flecainide