title: Perinatal treatment of refractory atrial flutter with hydrops fetalis: a case report.
abstract: OBJECTIVE
  Highlight the management of a critically ill premature hydropic baby with refractory atrial flutter (AF) and successful outcome without neurologic sequel at 1 year of follow-up.
  
  
  METHODS
  A 23-year-old pregnant woman, G1PO, presented with fetal tachycardia at 32 weeks.
  
  
  RESULTS
  Ultrasound revealed a hydropic fetus with fetal atrial rate (FHR) of 440 bpm and A:V block of 2:1. Transplacental therapy resulted in a temporary response with the combination of digoxin and flecainide, and subsequently digoxin plus sotalol. Termination of pregnancy at 34 weeks was performed for postnatal treatment, giving birth to a premature hydropic baby, weighing 3320 grams. At birth flecainide failed to control the AF Therefore, intravenous adenosine was started and successful conversion to normal sinus rhythm was temporally achieved. Finally, conversion to normal sinus rhythm with amiodarone plus digoxin was satisfactorily achieved and then long-term control with only oral flecainide. The hydropic signs gradually disappeared without any significant sequelae. The baby was healthy at one year of follow-up without any neurological sequelae.
  
  
  CONCLUSIONS
  This case may be evidence that combined therapy with amiodarone and digoxin is probably effective in treatment of refractory AF with hydropic changes, at least in some cases.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Suleuwan@med.cmu.ac.th
authors.forename: Suchaya
authors.initials: S
authors.lastname: Luewan
authors.forename: Rekwan
authors.initials: R
authors.lastname: Sittiwangkul
authors.forename: Kasemsri
authors.initials: K
authors.lastname: Srisupundit
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001282:Atrial Flutter / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015150:Echocardiography, Doppler; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005865:Gestational Age; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D055815:Young Adult
chemical_list: D000889:Anti-Arrhythmia Agents