Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-17T01:33:44.825Z Has data issue: false hasContentIssue false
  • English
  • Français

Favourable outcome for hydrops or cardiac failure associated with fetal tachyarrhythmia: a 20-year review

Part of: Echocardiography

Published online by Cambridge University Press:  23 September 2021

Gulhan Tunca Sahin Open the ORCID record for Gulhan Tunca Sahin [Opens in a new window] ,
Robert Bryan Beattie  and
Orhan Uzun
Gulhan Tunca Sahin
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
Robert Bryan Beattie
Affiliation:
Department of Fetal Medicine, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK
Orhan Uzun*
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK
*
Author for correspondence: Prof. O. Uzun, Department of Pediatric Cardiology, University Hospital of Wales, Heath Park, Wales, Cardiff CF14 4XW, UK. Tel: +442920 744743; Fax: +44 2920 744745. E-mail: uzun@cardiff.ac.uk
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Hydrops fetalisfetaltachyarrhythmiacardiac failuredigoxinflecainide
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1077 - 1084
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Simpson, LL. Fetal supraventricular tachycardias: diagnosis and management. Semin Perinatol 2000; 24: 360–372.CrossRefGoogle ScholarPubMed
Simpson, JM, Sharland, GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart (British Cardiac Society) 1998; 79: 576–581.Google ScholarPubMed
Hahurij, ND, Blom, NA, Lopriore, E, et al. Perinatal management and long-term cardiac outcome in fetal arrhythmia. Early Hum Dev 2011; 87: 83–87.CrossRefGoogle ScholarPubMed
Naheed, ZJ, Strasburger, JF, Deal, BJ, Benson, DW Jr., Gidding, SS. Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol 1996; 27: 1736–1740.CrossRefGoogle ScholarPubMed
Krapp, M, Kohl, T, Simpson, JM, Sharland, GK, Katalinic, A, Gembruch, U. Review of diagnosis, treatment, and outcome of fetal atrial flutter compared with supraventricular tachycardia. Heart (British Cardiac Society) 2003; 89: 913–917.CrossRefGoogle ScholarPubMed
Cuneo, BF, Strasburger, JF. Management strategy for fetal tachycardia. Obstet Gynecol 2000; 96: 575–581.Google ScholarPubMed
Hansmann, M, Gembruch, U, Bald, R, Manz, M, Redel, DA. Fetal tachyarrhythmias: transplacental and direct treatment of the fetus-a report of 60 cases. Ultrasound Obstetrics Gynecology Off J Int Soc Ultrasound Obstetrics Gynecology 1991; 1: 162–168.CrossRefGoogle ScholarPubMed
DeVore, GR. Assessing fetal cardiac ventricular function. Semin Fetal Neonat M 2005; 10: 515–541.CrossRefGoogle ScholarPubMed
Uzun, O, Beattie, B. Fetal heart irregularities & arrhythmias, antenatal management of. In Maternity Professional Forum and the Cardiff and Vale Health Board, 2018.Google Scholar
Uzun, O, Babaoglu, K, Sinha, A, Massias, S, Beattie, B. Rapid control of foetal supraventricular tachycardia with digoxin and flecainide combination treatment. Cardiol Young 2012; 22: 372–380.CrossRefGoogle ScholarPubMed
Tunca Sahin, G, Lewis, M, Uzun, O. Association of fetal atrial flutter with neonatal atrioventricular re-entry tachycardia involving accessory pathway: a link to be remembered. Pediatr Cardiol 2021; 42(4): 849–856.CrossRefGoogle ScholarPubMed
Huntley, M. The Griffiths Mental Developmental Scales Manual from Birth to Two Years. Association for Research in Infant and Child Development, Bucks, UK; The Test Agency, Oxford, UK, 1996: 5–39.Google Scholar
O'Leary, ET, Alexander, ME, Bezzerides, VJ, et al. Low mortality in fetal supraventricular tachycardia: outcomes in a 30-year single-institution experience. J Cardiovasc Electr 2020; 31: 1105–1113.10.1111/jce.14406CrossRefGoogle Scholar
Miyoshi, T, Maeno, Y, Sago, H, et al. Antenatal antiarrhythmic treatment for fetal tachyarrhythmias: a study protocol for a prospective multicentre trial. BMJ Open 2017; 7: e016597.CrossRefGoogle ScholarPubMed
Van der Heijden, LB, Oudijk, MA, Manten, GT, ter Heide, H, Pistorius, L, Freund, MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstetrics Gynecology Official Journal Int Soc Ultrasound Obstetrics Gynecology 2013; 42: 285–293.CrossRefGoogle ScholarPubMed
Jaeggi, ET, Carvalho, JS, De Groot, E, et al. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124: 1747–1754.CrossRefGoogle ScholarPubMed
Oudijk, MA, Michon, MM, Kleinman, CS, et al. Sotalol in the treatment of fetal dysrhythmias. Circulation 2000; 101: 2721–2726.CrossRefGoogle ScholarPubMed
Lulić Jurjević, R, Podnar, T, Vesel, S. Diagnosis, clinical features, management, and post-natal follow-up of fetal tachycardias. Cardiol Young 2009; 19: 486–493.CrossRefGoogle ScholarPubMed
Oudijk, MA, Visser, GH, Meijboom, EJ. Fetal tachyarrhythmia - part II: treatment. Indian Pacing Electrophysiol J 2004; 4: 185–194.Google ScholarPubMed
Fouron, JC. Fetal arrhythmias: the Saint-Justine hospital experience. Prenatal Diag 2004; 24: 1068–1080.CrossRefGoogle ScholarPubMed
Vigneswaran, TV, Callaghan, N, Andrews, RE, et al. Correlation of maternal flecainide concentrations and therapeutic effect in fetal supraventricular tachycardia. Heart Rhythm 2014; 11: 2047–2053.CrossRefGoogle ScholarPubMed
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: 1283–1288.CrossRefGoogle ScholarPubMed
Brugada, J, Katritsis, DG, Arbelo, E, et al. 2019 ESC guidelines for the management of patients with supraventricular tachycardiaThe task force for the management of patients with supraventricular tachycardia of the european society of cardiology (ESC). Eur Heart J 2020; 41: 655–720.10.1093/eurheartj/ehz467CrossRefGoogle ScholarPubMed
Allan, LD, Chita, SK, Sharland, GK, Maxwell, D, Priestley, K. Flecainide in the treatment of fetal tachycardias. Brit Heart J 1991; 65: 46–48.10.1136/hrt.65.1.46CrossRefGoogle ScholarPubMed
Sridharan, S, Sullivan, I, Tomek, V, et al. Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols. Heart Rhythm 2016; 13: 1913–1919.CrossRefGoogle ScholarPubMed
Hill, GD, Kovach, JR, Saudek, DE, Singh, AK, Wehrheim, K, Frommelt, MA. Transplacental treatment of fetal tachycardia: a systematic review and meta-analysis. Prenatal Diag 2017; 37: 1076–1083.CrossRefGoogle ScholarPubMed
Alsaied, T, Baskar, S, Fares, M, et al. First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: a systematic review and meta-analysis. J Am Heart Assoc 2017; 6.CrossRefGoogle ScholarPubMed
Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. New Eng J Med 1989; 321: 406–412.CrossRefGoogle Scholar
Cunningham, T, Uzun, O, Morris, R, et al. The safety and effectiveness of flecainide in children in the current era. Pediatr Cardiol 2017; 38: 1633–1638.CrossRefGoogle ScholarPubMed
Shah, A, Moon-Grady, A, Bhogal, N, et al. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol 2012; 109: 1614–1618.CrossRefGoogle ScholarPubMed
Strasburger, JF, Cuneo, BF, Michon, MM, et al. Amiodarone therapy for drug-refractory fetal tachycardia. Circulation 2004; 109: 375–379.CrossRefGoogle ScholarPubMed
Bartalena, L, Bogazzi, F, Braverman, LE, Martino, E. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest 2001; 24: 116–130.CrossRefGoogle ScholarPubMed
Jouannic, JM, Delahaye, S, Fermont, L, et al. Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy? Prenatal Diag 2003; 23: 152–156.10.1002/pd.542CrossRefGoogle ScholarPubMed
Krapp, M, Baschat, AA, Gembruch, U, Geipel, A, Germer, U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstetrics Gynecology Off J Int Soc Ultrasound Obstetrics Gynecology 2002; 19: 158–164.CrossRefGoogle ScholarPubMed
Oudijk, MA, Gooskens, RH, Stoutenbeek, P, De Vries, LS, Visser, GH, Meijboom, EJ. Neurological outcome of children who were treated for fetal tachycardia complicated by hydrops. Ultrasound Obstetrics Gynecology Official J Int Soc Ultrasound Obstetrics Gynecology 2004; 24: 154–158.CrossRefGoogle ScholarPubMed