title: Favorable neurodevelopmental outcome in a hypothyroid neonate following intracordal amiodarone for cardioversion of refractory supraventricular tachycardia in a fetus.
abstract: Fetal supraventricular tachycardia (SVT), characterized by a fetal ventricular heart rate faster than 200 beats per minute (bpm), is often diagnosed during routine fetal heart monitoring or prenatal ultrasound examinations. Clinical guidelines for management of fetal SVT have not been determined in standardized trials, nor do we have a clear sense regarding the long-term developmental outcomes and side effects of in utero antiarrhythmic therapy. We describe our approach to the treatment of refractory SVT in a fetus with hydrops using direct umbilical vein treatment with amiodarone coupled with effusion evacuation. We successfully achieved in utero resolution of SVT. There was transient amiodarone-induced hypothyroidism, which we screened for early and treated with Synthroid. Ultimately our patient had normal long-term growth and development as measured by modified Denver office checklists and Ages and Stages questionnaires. Our experience advocates for vigilant screening and management of hypothyroidism in fetuses exposed to in utero amiodarone and suggests that it is possible to achieve good outcomes in high-acuity refractory cases of SVT.
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore-Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Capone
authors.affiliation: Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gebb
authors.affiliation: Department of Obstetrics, Gynecology & Women's Health, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: P
authors.initials: P
authors.lastname: Dar
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, The Children's Hospital at Montefiore-Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: R U
authors.initials: RU
authors.lastname: Shenoy
mesh_terms: D000328:Adult; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006801:Humans; D015160:Hydrops Fetalis / Q000000981:diagnostic imaging; D007037:Hypothyroidism / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D007231:Infant, Newborn; D011247:Pregnancy; D013617:Tachycardia, Supraventricular / Q000188:drug therapy*; D013974:Thyroxine / Q000627:therapeutic use; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone; D013974:Thyroxine
keywords: Fetal arrhythmias; amiodarone-induced hypothyroidism; cardioversion; hydrops fetalis; neurodevelopment