Fetal atrial flutter: a case report and experience of sotalol treatment.
OBJECTIVE
Fetal tachyarrhythmia may cause fetal hydrops and lead to fetal morbidity and mortality. Supraventricular tachycardia and atrial flutter have been the most diagnosed. We present a case of fetal atrial flutter diagnosed during the second trimester treated with digoxin and sotalol and delivered at term.


METHODS
A 30-year-old primigravid woman was diagnosed with fetal atrial flutter at the gestational age of 25 weeks with atrial rates of 480-520 bpm and ventricular rates of 200-250 bpm. Initially, she was treated with digoxin then with a combination of digoxin and sotalol. The fetal heart beat slowed after sotalol treatment but did not return to sinus rhythm. The fetus was delivered vaginally. Neonatal echocardiography showed a small apical ventricular septal defect and small patent ductus arteriosus. Electrocardiography also revealed atrial flutter with occasional atrial fibrillation.


CONCLUSIONS
The efficacy of antiarrhythmic drug therapy for fetal atrial flutter has not been well established. In our case, we used sotalol combined with digoxin and the fetal heart beat slowed after therapy. Sotalol may be considered the drug of choice for fetal atrial flutter. If the fetal atrial flutter is resistant to these therapies, a combination of other congenital cardiac diseases or organic abnormalities should be considered.
Wu
Tsui-Hua
TH
Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.
Huang
Li-Chia
LC
Ho
Ming
M
Lee
Chien-Chung
CC
Chiu
Tsan-Hung
TH
Hung
Yao-Ching
YC
D000284:Administration, Oral; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging; D001282:Atrial Flutter / Q000150:complications / Q000000981:diagnostic imaging / Q000196:embryology*; D036861:Delivery, Obstetric; D004077:Digoxin / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006340:Heart Rate, Fetal / Q000187:drug effects; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D013015:Sotalol / Q000008:administration & dosage / Q000627:therapeutic use*
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol