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Rapid control of foetal supraventricular tachycardia with digoxin and flecainide combination treatment

Published online by Cambridge University Press:  29 September 2011

Orhan Uzun ,
Kadir Babaoglu ,
Anju Sinha ,
Spyridon Massias  and
Bryan Beattie
Orhan Uzun*
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Kadir Babaoglu
Affiliation:
Department of Paediatric Cardiology, Kocaeli University Medical Faculty, Kocaeli, Turkiye
Anju Sinha
Affiliation:
Department of Obstetric and Gynaecology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Spyridon Massias
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
Bryan Beattie
Affiliation:
Department of Obstetric and Gynaecology, University Hospital of Wales, Cardiff, Wales, United Kingdom
*
Correspondence to: Dr O. Uzun, Department of Paediatric Cardiology, University Hospital of Wales, Cardiff, CF14 4XW, Wales, United Kingdom. Tel: 02920744743; Fax: 02920744744; E-mail: orhan.uzun@wales.nhs.uk
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Abstract

Objectives

To evaluate the efficacy of flecainide and digoxin combination in foetal supraventricular tachycardia.

Setting

This study was carried out in a tertiary referral centre.

Methods

We conducted a retrospective review of 29 patients diagnosed with supraventricular foetal tachycardia between 2001 and 2009. Mode of presentation, foetal cardiac function, maternal anti-arrhythmic serum levels, drug tolerance, and maternal electrocardiogram recordings were assessed. The postnatal outcome of each infant was also evaluated for tachycardia recurrence.

Results

In all, 27 foetuses were treated with digoxin and flecainide combination, and two foetuses were delivered without any treatment. Of the 27 foetuses, seven had atrial flutter and the remaining 22 had atrioventricular re-entry tachycardia. There were eight foetuses with hydrops (27%), of whom three had atrial flutter and five had atrioventricular re-entry tachycardia; 26 foetuses (96%) responded to flecainide and digoxin combination, with restoration of sinus rhythm in 22 (81.4%) and rate control in the other four. In one severely hydropic foetus, there was no response to treatment. In all, 26 treated infants were delivered alive, but one pregnancy was terminated for non-cardiac causes when the foetus was in sinus rhythm. There was no intrauterine death due to tachycardia. Although there were minor side effects to anti-arrhythmic medications, none of the pregnant women developed proarrhythmia.

Conclusion

Flecainide and digoxin combination treatment offers a safe and effective treatment for foetal supraventricular tachycardia with fast restoration of sinus rhythm.

Keywords

Foetusarrhythmiaanti-arrhythmic drugsdigoxinflecainide
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 4 , August 2012 , pp. 372 - 380
Copyright
Copyright © Cambridge University Press 2012

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