Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias
The American Journal of Cardiology, 06/01/2012
Shah A et al. – Transplacental sotalol, alone or combined with digoxin, is effective for the treatment of fetal supraventricular tachycardia (SVT) and atrial flutter (AF), with an 85% complete or partial response rate in this series.Methods
- The present study was a retrospective review of the clinical, echocardiographic, and electrocardiographic data from all pregnancies with fetal tachycardia diagnosed and managed at a single center from 2004 to 2008.
- Of 29 affected pregnancies, 21 (16 SVT and 5 AF) were treated with sotalol at presentation, with or without concurrent administration of digoxin.
- Of the 21, 11 (6 SVT and 5 AF) had resolution of the tachycardia within 5 days (median 1).
- Six others showed some response (less frequent tachycardia, rate slowing, resolution of hydrops) without complete conversion.
- In 1 fetus with a slow response, the mother chose pregnancy termination.
- The 5 survivors with a slow response were all difficult to treat postnatally, including 1 requiring radiofrequency ablation as a neonate.
- One fetus developed blocked atrial extrasystoles after 1 dose of sotalol and was prematurely delivered for fetal bradycardia.
- Three grossly hydropic fetuses with SVT showed no response and died within 1 to 3 days of treatment.