1
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Favourable outcome for hydrops or cardiac failure associated with fetal tachyarrhythmia: a 20-year review. Cardiol Young 2022; 32:1077-1084. [PMID: 34551832 DOI: 10.1017/s104795112100367x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Prognosis of fetuses with hydrops and tachyarrhythmia has been portrayed as poor in most published reports. This might lead to biased counselling, unnecessary caesarean section, preterm delivery, and even termination of pregnancy. AIMS To evaluate contemporary fetal and postnatal outcomes of hydropic fetuses with fetal tachyarrhythmia when it is treated effectively and monitored systematically. METHODS This is a retrospective review of a single centre experience at the University Hospital of Wales over a 20-year period. All fetuses received high doses of flecainide and digoxin combination treatment. Tachycardia response rate, time to arrhythmia and hydrops resolution, fetal and postnatal morbidity, and mortality rates were analysed. RESULTS Twenty fetuses were diagnosed with hydrops fetalis and received treatment. The mechanism of fetal tachyarrhythmia was supraventricular tachycardia in thirteen and atrial flutter in eight cases. Among the 20 fetuses treated, the overall tachycardia response rate was 90% (18/20) with the restoration of sinus rhythm in 85% (17/20) of the cases. The median time to restore sinus rhythm or to rate control of the arrhythmia was 1.5 days (range 12 hours to 13 days). Hydrops resolved in 17 of the 20 fetuses, with a median time of 12 days (range 3-21 days). Four fetuses went into spontaneous preterm birth and one fetus was delivered early due to worsening hydrops. No significant neurological morbidity was observed in surviving neonates and infants on clinical examination. There was one postnatal death due to respiratory complications of prematurity in the non-responsive supraventricular tachycardia case. CONCLUSIONS High-dose flecainide and digoxin combination offers effective treatment strategy in fetuses with hydrops and tachyarrhythmia with favourable outcomes. This study may guide more realistic counselling for pregnancies complicated by tachyarrhythmia and hydrops.
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2
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Gozar L, Gabor-Miklosi D, Toganel R, Fagarasan A, Gozar H, Toma D, Cerghit-Paler A. Fetal Tachyarrhythmia Management from Digoxin to Amiodarone-A Review. J Clin Med 2022; 11:jcm11030804. [PMID: 35160256 PMCID: PMC8836967 DOI: 10.3390/jcm11030804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/21/2022] Open
Abstract
Sustained fetal tachycardias are rare but represent a high risk of mortality and morbidity. Consensus has yet to be found regarding their optimal management. The aim of this narrative review is to summarize the data available in the current literature regarding the efficacy and safety of medications used in the management of intrauterine tachyarrhythmias and to provide possible treatment protocols. In this review, we would like to emphasize the importance of a thorough evaluation of both the fetus and the mother, prior to transplacental antiarrhythmic drug initiation. Factors such as the hemodynamic status of the fetus, possible mechanisms of fetal arrhythmia, and concomitant maternal conditions are of primordial importance. As a possible treatment protocol, we would like to recommend the following: due to the risk of sustained supraventricular tachycardia (SVT), fetuses with frequent premature atrial beats should be evaluated more frequently by echocardiography. A careful hemodynamic evaluation of a fetus with tachycardia is primordial in forestalling the appearance of hydrops. In the case of atrial flutter (AFL), sotalol therapy could represent a first choice, whereas when dealing with SVT patients, flecainide should be considered, especially for hydropic patients. These data require consolidation through larger scale, non-randomized studies and should be handled with caution.
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Affiliation(s)
- Liliana Gozar
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania; (L.G.); (R.T.); (A.F.); (D.T.); (A.C.-P.)
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Dorottya Gabor-Miklosi
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
- Correspondence: ; Tel.: +40-740-371-322
| | - Rodica Toganel
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania; (L.G.); (R.T.); (A.F.); (D.T.); (A.C.-P.)
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Amalia Fagarasan
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania; (L.G.); (R.T.); (A.F.); (D.T.); (A.C.-P.)
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Horea Gozar
- Department of Pediatric Surgery, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania;
| | - Daniela Toma
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania; (L.G.); (R.T.); (A.F.); (D.T.); (A.C.-P.)
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
| | - Andreea Cerghit-Paler
- Department of Pediatrics, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, 540139 Târgu-Mureș, Romania; (L.G.); (R.T.); (A.F.); (D.T.); (A.C.-P.)
- Pediatric Cardiology, Emergency Institute of Cardiovascular Diseases and Transplantation, 540139 Târgu-Mureș, Romania
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3
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Takatsuka H, Wakabayashi K, Yamazaki S, Tanaka H, Omoto A, Suzuki T, Shozu M, Ishii I. Transition of maternal serum concentration of digoxin and flecainide in the third trimester-A case report of fetal supraventricular tachycardia with hydrops. Clin Case Rep 2021; 9:e03992. [PMID: 34026129 PMCID: PMC8117821 DOI: 10.1002/ccr3.3992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/30/2020] [Accepted: 02/13/2021] [Indexed: 11/25/2022] Open
Abstract
When transplacental therapy is conducted, the maternal serum concentrations of digoxin and flecainide may fluctuate throughout third trimester. Therefore, TDM may be effective in improving the efficacy and safety of treatment.
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Affiliation(s)
| | | | | | - Hirokazu Tanaka
- Department of Obstetrics and Gynecology International University of Health and Welfare Narita Hospital Chiba Japan
| | - Akiko Omoto
- Department of Maternal-Fetal Medicine Chiba University Hospital Chiba Japan
| | - Takaaki Suzuki
- Division of Pharmacy Chiba University Hospital Chiba Japan.,Graduate School of Pharmaceutical Sciences Chiba University Chiba Japan
| | - Makio Shozu
- Department of Reproductive Medicine Graduate School of Medicine Chiba University Chiba Japan
| | - Itsuko Ishii
- Division of Pharmacy Chiba University Hospital Chiba Japan.,Graduate School of Pharmaceutical Sciences Chiba University Chiba Japan
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4
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Bartin R, Maltret A, Nicloux M, Ville Y, Bonnet D, Stirnemann J. Outcomes of sustained fetal tachyarrhythmias after transplacental treatment. Heart Rhythm O2 2021; 2:160-167. [PMID: 34113918 PMCID: PMC8183966 DOI: 10.1016/j.hroo.2021.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Fetal tachyarrhythmia is a condition that may lead to cardiac dysfunction, hydrops, and death. Despite a transplacental treatment, failure to obtain or maintain sinus rhythm may occur. Objective We aimed to analyze the perinatal outcomes of sustained fetal tachyarrhythmias after in utero treatment. Methods We performed a retrospective evaluation of 69 cases with sustained fetal tachyarrhythmia. We compared the perinatal and long-term outcomes of prenatally converted and drug-resistant fetuses. Tachyarrhythmia subtypes were also evaluated. Results Conversion to sinus rhythm was obtained in 74% of cases; 26% of cases were drug-resistant and delivered arrhythmic. Three perinatal deaths occurred in both groups (6.7% vs 17%, P = .34). Neonates delivered arrhythmic were more frequently admitted to neonatal intensive care units (75% vs 31%, P < .01), and their hospital stay was longer (20.9 vs 6.64 days, P < .001). Multiple neonatal recurrences (81% vs 11%, P < .001), temporary hemodynamic dysfunction or heart failure (50% vs 6.7%, P < .001), and postnatal use of a combination treatment (44% vs 13%, P = .028) were also more frequent in this population. Beyond the neonatal period, rates of recurrences within the first 16 months were higher in drug-resistant fetuses (HR = 16.14, CI 95% [4.485; 193.8], P < .001). In this population, postnatal electrocardiogram revealed an overrepresentation of rare mechanisms, especially permanent junctional reciprocating tachycardia (PJRT) (31%). Conclusion Prenatal conversion to stable sinus rhythm is a major determinant of perinatal and long-term outcomes in fetal tachyarrhythmias. The underlying electrophysiological mechanisms have a major role in predicting these differential outcomes with an overrepresentation of PJRT in the drug-resistant population.
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Affiliation(s)
- Raphael Bartin
- Obstetric and Maternal Fetal Medicine and EA7328.,Hôpital universitaire Necker-Enfants malades, AP-HP
| | - Alice Maltret
- M3C-Necker, Pediatric and Congenital Cardiology Unit.,Hôpital universitaire Necker-Enfants malades, AP-HP
| | - Muriel Nicloux
- Neonatology and Neonatal Intensive Care Unit.,Hôpital universitaire Necker-Enfants malades, AP-HP
| | - Yves Ville
- Obstetric and Maternal Fetal Medicine and EA7328.,Hôpital universitaire Necker-Enfants malades, AP-HP.,Université de Paris, Paris, France
| | - Damien Bonnet
- M3C-Necker, Pediatric and Congenital Cardiology Unit.,Hôpital universitaire Necker-Enfants malades, AP-HP.,Université de Paris, Paris, France
| | - Julien Stirnemann
- Obstetric and Maternal Fetal Medicine and EA7328.,Hôpital universitaire Necker-Enfants malades, AP-HP.,Université de Paris, Paris, France
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5
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Vigneswaran TV, Rosenthal E, Bakalis S, Nelson-Piercy C, Chappell L, Simpson JM. Transplacental metoprolol for fetal supraventricular tachycardia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:462-464. [PMID: 31743523 DOI: 10.1002/uog.21924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Affiliation(s)
- T V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - E Rosenthal
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
| | - S Bakalis
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - C Nelson-Piercy
- Department of Women's Health, Guy's & St Thomas' Hospital, London, UK
| | - L Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, London, UK
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6
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O'Leary ET, Alexander ME, Bezzerides VJ, Drogosz M, Economy KE, Friedman KG, Pickard SS, Tworetzky W, Mah DY. Low mortality in fetal supraventricular tachycardia: Outcomes in a 30-year single-institution experience. J Cardiovasc Electrophysiol 2020; 31:1105-1113. [PMID: 32100356 DOI: 10.1111/jce.14406] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/31/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe a single institutional experience managing fetuses with supraventricular tachycardia (SVT) and to identify associations between patient characteristics and fetal and postnatal outcomes. BACKGROUND Sustained fetal SVT is associated with significant morbidity and mortality if untreated, yet the optimal management strategy remains unclear. METHODS Retrospective cohort study including fetuses diagnosed with sustained SVT (>50% of the diagnostic echocardiogram) between 1985 and 2018. Fetuses with congenital heart disease were excluded. RESULTS Sustained SVT was diagnosed in 65 fetuses at a median gestational age of 30 weeks (range, 14-37). Atrioventricular re-entrant tachycardia and atrial flutter were the most common diagnoses, seen in 41 and 16 cases, respectively. Moderate/severe ventricular dysfunction was present in 20 fetuses, and hydrops fetalis was present in 13. Of the 57 fetuses initiated on transplacental drug therapy, 47 received digoxin first-line, yet 39 of 57 (68%) required advanced therapy with sotalol, flecainide, or amiodarone. Rate or rhythm control was achieved in 47 of 57 treated fetuses. There were no cases of intrauterine fetal demise. Later gestational age at fetal diagnosis (odds ratio [OR], 1.1, 95% confidence interval [CI], 1.01-1.2, P = .02) and moderate/severe fetal ventricular dysfunction (OR, 6.1, 95% CI, 1.7-21.6, P = .005) were associated with postnatal SVT. Two postnatal deaths occurred. CONCLUSIONS Fetuses with structurally normal hearts and sustained SVT can be effectively managed with transplacental drug therapy with minimal risk of intrauterine fetal demise. Treatment requires multiple antiarrhythmic agents in over half of cases. Later gestational age at fetal diagnosis and the presence of depressed fetal ventricular function, but not hydrops, predict postnatal arrhythmia burden.
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Affiliation(s)
- Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Monika Drogosz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katherine E Economy
- Harvard Medical School, Boston, Massachusetts.,Department of Maternal-Fetal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kevin G Friedman
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sarah S Pickard
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Wayne Tworetzky
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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7
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Refaat M, El Dick J, Sabra M, Bitar F, Tayeh C, Abutaqa M, Arabi M. Sotalol as an effective adjunct therapy in the management of supraventricular tachycardia induced fetal hydrops fetalis. J Neonatal Perinatal Med 2020; 13:267-273. [PMID: 31707376 DOI: 10.3233/npm-190268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin combination therapy in the second and review the literature for the management of fetal SVT.
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Affiliation(s)
- Marwan Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Joud El Dick
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Mohammad Sabra
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Tayeh
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Abutaqa
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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8
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Flecainide: Electrophysiological properties, clinical indications, and practical aspects. Pharmacol Res 2019; 148:104443. [PMID: 31493514 DOI: 10.1016/j.phrs.2019.104443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/03/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022]
Abstract
Over the last 35 years, flecainide proved itself one of the most commonly used arrhythmic drugs, expanding its original indication for ventricular arrhythmias and results nowadays as the cornerstone of the rhythm control strategy in atrial fibrillation management of patients without structural heart disease. While the increased mortality associated with flecainide in the Cardiac Arrhythmia Suppression Trial (CAST) still casts his shadow over flecainide clinical profile, this compound has subsequently demonstrated safe and is now used successfully for a plethora of indications, including pharmacological cardioversion of atrial fibrillation, cathecolaminergic polymorphic ventricular tachycardia, supraventricular tachyarrhythmias and ventricular pre-excitation. Moreover, the recent marketing of a controlled release formulation, along with the intravenous and immediate release formulations, increased the armamentarium to the clinician's disposal while improving patients' compliance. In the present paper, we offer a comprehensive review of the anti-arrhythmic effects of flecainide, detailing its electrophysiological properties, its effects on the conduction system, its clinical use and the major side effects and contraindications in clinical practice.
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9
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Chauveau S, Le Vavasseur O, Morel E, Dulac A, Chevalier P. Flecainide is a safe and effective treatment for pre-excited atrial fibrillation rapidly conducted to the ventricle in pregnant women: a case series. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5522158. [PMID: 31449645 PMCID: PMC6601159 DOI: 10.1093/ehjcr/ytz066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 06/10/2019] [Indexed: 11/14/2022]
Abstract
Background Pregnancy is associated with an increased incidence of cardiac arrhythmias likely due to hormonal, haemodynamic, and autonomic changes. Yet, there is little data available regarding the efficacy and safety of anti-arrhythmic agents to prevent pre-excited atrial fibrillation (AF) in pregnant women. Case summary We report on three pregnant women who developed AF rapidly conducted to the ventricle through an overt accessory pathway as the first manifestation of Wolff–Parkinson–White syndrome. Discussion All patients were treated with flecainide with neither arrhythmias recurrence nor adverse events of the treatment. Mechanisms of action and clinical efficacy of flecainide are discussed.
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Affiliation(s)
- Samuel Chauveau
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France.,Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
| | - Olivier Le Vavasseur
- Department of Cardiology, Northwest Hospital, Gleizé, France Hospital, 39 Plateau d'Ouilly Gleizé, Gleize, France
| | - Elodie Morel
- Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
| | - Arnaud Dulac
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France
| | - Philippe Chevalier
- Department of Rhythmology, Hospices Civils de Lyon, Louis Pradel Cardiovascular Hospital, 26 Avenue du Doyen jean Lépine, Lyon, France.,Lyon Reference Center for Inherited Arrhythmias, Louis Pradel Cardiovascular Hospital, 28 avenue Doyen Lépine, Bron, France
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10
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Pedra SRFF, Zielinsky P, Binotto CN, Martins CN, Fonseca ESVBD, Guimarães ICB, Corrêa IVDS, Pedrosa KLM, Lopes LM, Nicoloso LHS, Barberato MFA, Zamith MM. Brazilian Fetal Cardiology Guidelines - 2019. Arq Bras Cardiol 2019; 112:600-648. [PMID: 31188968 PMCID: PMC6555576 DOI: 10.5935/abc.20190075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Simone R F Fontes Pedra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil.,Hospital do Coração (HCor), São Paulo, SP - Brazil
| | - Paulo Zielinsky
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil
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11
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Malhamé I, Gandhi C, Tarabulsi G, Esposito M, Lombardi K, Chu A, Chen KK. Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia. Obstet Med 2019; 12:66-75. [PMID: 31217810 PMCID: PMC6560838 DOI: 10.1177/1753495x18808118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/25/2018] [Indexed: 11/16/2022] Open
Abstract
Fetal tachycardia is a rare complication during pregnancy. After exclusion of maternal and fetal conditions that can result in a secondary fetal tachycardia, supraventricular tachycardia is the most common cause of a primary sustained fetal tachyarrhythmia. In cases of sustained fetal supraventricular tachycardia, maternal administration of digoxin, flecainide, sotalol, and more rarely amiodarone, is considered. As these medications have the potential to cause significant adverse effects, we sought to examine maternal safety during transplacental treatment of fetal supraventricular tachycardia. In this narrative review we summarize the literature addressing pharmacologic properties, monitoring, and adverse reactions associated with medications most commonly prescribed for transplacental therapy of fetal supraventricular tachycardia. We also describe maternal monitoring practices and adverse events currently reported in the literature. In light of our findings, we provide clinicians with a suggested maternal monitoring protocol aimed at optimizing safety.
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Affiliation(s)
- Isabelle Malhamé
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Christy Gandhi
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Gofran Tarabulsi
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Matthew Esposito
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, RI, USA
| | - Kristin Lombardi
- Department of Pediatrics, Hasbro Children’s Hospital, Providence, RI, USA
| | - Antony Chu
- Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Kenneth K Chen
- Department of Medicine, Women and Infants Hospital, Providence, RI, USA
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12
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Carvalho JS. Fetal dysrhythmias. Best Pract Res Clin Obstet Gynaecol 2019; 58:28-41. [PMID: 30738635 DOI: 10.1016/j.bpobgyn.2019.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/31/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022]
Abstract
Fetal dysrhythmias are common abnormalities, usually manifesting as irregular rhythms. Although most irregularities are benign and caused by isolated atrial ectopics, in a few cases, rhythm irregularity may indicate partial atrioventricular block, which has different etiological and prognostic implications. We provide a flowchart for the initial management of irregular rhythm to help select cases requiring urgent specialist referral. Tachycardias and bradycardias are less frequent, can lead to hemodynamic compromise, and may require in utero therapy. Pharmacological treatment of tachycardia depends on the type (supraventricular tachycardia or atrial flutter) and presence of hydrops, with digoxin, flecainide, and sotalol being commonly used. An ongoing randomized trial may best inform about their efficacy. Bradycardia due to blocked bigeminy normally resolves spontaneously, but if it is due to established complete heart block, there is no effective treatment. Ongoing research suggests hydroxychloroquine may reduce the risk of autoimmune atrioventricular block. Sinus bradycardia (rate <3rd centile) may be a prenatal marker for long-QT syndrome.
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Affiliation(s)
- Julene S Carvalho
- Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK; Fetal Medicine Unit, St George's University Hospital, Blackshaw Road, London, SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
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13
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Abstract
Fetal cardiac abnormalities are some of the commonest congenital disorders seen in prenatal life. They can be anatomical or functional and can develop de novo or as a consequence of either maternal or fetal disease. Untreated, morbidity and mortality rates are high for hypoplastic left heart disorders and for some fetal tachy and bradyarrhythmias. Optimum management strategies are often not clear because of the lack of knowledge about the precise natural history of some of these conditions. Prenatal therapy ranges from invasive fetal cardiac intervention to maternal administration of drugs for transplacental transfer to the fetus. This comprehensive review covers many fetal cardiac disorders and various prenatal therapeutic options that are available.
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Affiliation(s)
- Sailesh Kumar
- a Mater Research Institute / University of Queensland , Brisbane , Australia.,b Mater Centre for Maternal Fetal Medicine , Mater Mothers' Hospital , Brisbane , Australia.,c Faculty of Medicine , the University of Queensland , Brisbane , Australia
| | - Jade Lodge
- b Mater Centre for Maternal Fetal Medicine , Mater Mothers' Hospital , Brisbane , Australia
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14
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Pregnancy and newborn outcomes in arrhythmogenic right ventricular cardiomyopathy/dysplasia. Int J Cardiol 2018; 258:172-178. [DOI: 10.1016/j.ijcard.2017.11.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/03/2017] [Accepted: 11/20/2017] [Indexed: 11/18/2022]
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15
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Ekiz A, Kaya B, Bornaun H, Acar DK, Avci ME, Bestel A, Yildirim G. Flecainide as first-line treatment for fetal supraventricular tachycardia. J Matern Fetal Neonatal Med 2017; 31:407-412. [DOI: 10.1080/14767058.2017.1286317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ali Ekiz
- Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Basak Kaya
- Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Helen Bornaun
- Department of Pediatric Cardiology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Deniz Kanber Acar
- Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Muhittin Eftal Avci
- Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Aysegul Bestel
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Yildirim
- Department of Obstetrics and Gynecology, Maternal–Fetal Medicine Unit, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Strizek B, Berg C, Gottschalk I, Herberg U, Geipel A, Gembruch U. High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm 2016; 13:1283-8. [DOI: 10.1016/j.hrthm.2016.01.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Indexed: 11/29/2022]
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Burkart TA, Miles WM, Conti JB. Principles of Arrhythmia Management During Pregnancy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2016. [DOI: 10.15212/cvia.2015.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cuneo BF, Benson DW. Use of maternal flecainide concentration in management of fetal supraventricular tachycardia: a step in the right direction. Heart Rhythm 2014; 11:2054-5. [PMID: 25128734 DOI: 10.1016/j.hrthm.2014.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Bettina F Cuneo
- Children's Hospital Colorado, University of Colorado School of Medicine Denver, Colorado
| | - D Woodrow Benson
- Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
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