Can digoxin and sotalol therapy for fetal supraventricular tachycardia and hydrops be successful? A case report.
BACKGROUND
Neonatal survival and prognosis are closely linked with development of hydrops in cases of sustained fetal tachycardia. Several antiarrhythmic medications are available for conversion to sinus rhythm.


METHODS
An 18-year-old woman had an audible fetal arrhythmia at 25 weeks' gestation. Fetal echocardiography revealed supraventricular tachycardia with worsening cardiac function at 28 weeks. Digoxin therapy was initiated and sotalol was later added for new-onset hydrops. The medications were then adjusted, and the fetus' heart rate converted to sinus rhythm with resolution of the hydrops. The patient was then managed as an outpatient with antenatal testing, serial laboratory studies and electrocardiograms until 39 weeks.


CONCLUSIONS
Digoxin and sotalol therapy can be successful in blocking likely nodal reentry in sustained fetal supraventricular tachycardia, thus allowing resolution of hydrops with a favorable outcome.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania Medical Center, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. jmerriman@obgyn.upenn.edu
Jennifer B
JB
Merriman
Juan M
JM
Gonzalez
Jack
J
Rychik
Serdar H
SH
Ural
D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use*; D005260:Female; D046128:Fetal Therapies; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011247:Pregnancy; D013015:Sotalol / Q000627:therapeutic use*; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000196:embryology; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal
D000889:Anti-Arrhythmia Agents; D004077:Digoxin; D013015:Sotalol