Objective To evaluate the efficacy of flecainide and digoxin combination in acute management of fetal supraventricular tachycardia (SVT) in a tertiary referral centre.
Methods Retrospective review of all pregnant women referred with fetal SVT between January 2001 and March 2009. Data were obtained from Fetal Medicine database, Cardiobase and the maternal notes. The notes were carefully scrutinised to rule out any confounding variables.
Transabdominal fetal echocardiography was performed to confirm and to determine the type of arrhythmia, cardiac function and to exclude any associated structural abnormality or hydrops. All studies were recorded on a hard drive and videotapes for subsequent playback and analysis.
Results 29 cases of fetal SVT presented between 18- and 39-week gestation with a median maternal age of 27 years. 27 were treated with digoxin and flecainide combination. Two were delivered without treatment as both fetuses were at term. Seven fetuses had atrial flutter and remaining 22 had atrioventricular re-entry tachycardia. Hydrops was encountered in six patients, two of whom had atrial flutter and four, atrioventricular re-entry tachycardia. 26 responded to Flecainide and digoxin combination. The time to conversion ranged from less than 24 h to 21 days. Severe hydrops was encountered in one case which was resistant to all intervention. There were no intrauterine deaths due to tachycardia but one pregnancy was terminated due to major non-cardiac abnormalities.
Conclusion Combination of Flecainide and Digoxin offers a safe and effective treatment option for fetal SVT with rapid restoration of sinus rhythm.
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