Treatment, not delivery, of the late preterm and term fetus with supraventricular arrhythmia.
Female
Humans
Infant
Infant, Newborn
Pregnancy
Anti-Arrhythmia Agents
/ therapeutic use
Atrial Flutter
/ drug therapy
Cesarean Section
Digoxin
/ therapeutic use
Edema
Fetal Diseases
/ diagnostic imaging
Fetus
Hydrops Fetalis
Retrospective Studies
Tachycardia
Tachycardia, Supraventricular
/ drug therapy
Cesarean delivery
fetal arrhythmia
fetal echocardiography
fetal tachycardia
prenatal treatment
Journal
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology
ISSN: 1469-0705
Titre abrégé: Ultrasound Obstet Gynecol
Pays: England
ID NLM: 9108340
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
31
03
2023
received:
23
01
2023
accepted:
18
04
2023
medline:
4
10
2023
pubmed:
2
5
2023
entrez:
2
5
2023
Statut:
ppublish
Résumé
While in-utero treatment of sustained fetal supraventricular arrhythmia (SVA) is standard practice in the previable and preterm fetus, data are limited on best practice for late preterm (34 + 0 to 36 + 6 weeks), early term (37 + 0 to 38 + 6 weeks) and term (> 39 weeks) fetuses with SVA. We reviewed the delivery and postnatal outcomes of fetuses at ≥ 35 weeks of gestation undergoing treatment rather than immediate delivery. This was a retrospective case series of fetuses presenting at ≥ 35 weeks of gestation with sustained SVA and treated transplacentally at six institutions between 2012 and 2022. Data were collected on gestational age at presentation and delivery, SVA diagnosis (short ventriculoatrial (VA) tachycardia, long VA tachycardia or atrial flutter), type of antiarrhythmic medication used, interval between treatment and conversion to sinus rhythm and postnatal SVA recurrence. Overall, 37 fetuses presented at a median gestational age of 35.7 (range, 35.0-39.7) weeks with short VA tachycardia (n = 20), long VA tachycardia (n = 7) or atrial flutter (n = 10). Four (11%) fetuses were hydropic. In-utero treatment led to restoration of sinus rhythm in 35 (95%) fetuses at a median of 2 (range, 1-17) days; this included three of the four fetuses with hydrops. Antiarrhythmic medications included flecainide (n = 11), digoxin (n = 7), sotalol (n = 11) and dual therapy (n = 8). Neonates were liveborn at 36-41 weeks via spontaneous vaginal delivery (23/37 (62%)) or Cesarean delivery (14/37 (38%)). Cesarean delivery was indicated for fetal SVA in two fetuses, atrial ectopy or sinus bradycardia in three fetuses and obstetric reasons in nine fetuses that were in sinus rhythm at the time of delivery. Twenty-one (57%) cases were treated for recurrent SVA after birth. In-utero treatment of the near term and term (≥ 35-week) SVA fetus is highly successful even in the presence of hydrops, with the majority of cases delivered vaginally closer to term, thereby avoiding unnecessary Cesarean section. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Substances chimiques
Anti-Arrhythmia Agents
0
Digoxin
73K4184T59
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
552-557Informations de copyright
© 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Références
Reed KL. Fetal arrhythmias: etiology, diagnosis, pathophysiology, and treatment. Semin Perinatol 1989; 13: 294-304.
Vergani P, Mariani E, Ciriello E, Locatelli A, Strobelt N, Galli M, Ghidini A. Fetal arrhythmias: natural history and management. Ultrasound Med Biol 2005; 31: 1-6.
Jaeggi E, Öhman A. Fetal and neonatal arrhythmias. Clin Perinatol 2016; 43: 99-112.
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.
Donofrio MT, Moon-Grady AJ, Hornberger LK, Copel JA, Sklansky MS, Abuhamad A, Cuneo BF, Huhta JC, Jonas RA, Krishnan A, Lacey S, Lee W, Michelfelder EC Sr, Rempel GR, Silverman NH, Spray TL, Strasburger JF, Tworetzky W, Rychik J; American Heart Association Adults with Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 2014; 129: 2183-2242.
Krapp M, Baschat AA, Gembruch U, Geipel A, Germer U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol 2002; 19: 158-164.
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.
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 2018; 31: 407-412.
Alsaied T, Baskar S, Fares M, Alahdab F, Czosek RJ, Murad MH, Prokop LJ, Divanovic AA. First-line antiarrhythmic transplacental treatment for fetal tachyarrhythmia: A systematic review and meta-analysis. J Am Heart Assoc 2017; 6: e007164.
Miyoshi T, Maeno Y, Hamasaki T, Inamura N, Yasukochi S, Kawataki M, Horigome H, Yoda H, Taketazu M, Nii M, Hagiwara A, Kato H, Shimizu W, Shiraishi I, Sakaguchi H, Ueda K, Katsuragi S, Yamamoto H, Sago H, Ikeda T; Japan fetal arrhythmia group. Antenatal therapy for fetal supraventricular tachyarrhythmias: Multicenter trial. J Am Coll Cardiol 2019; 74: 874-885.
Manuck TA, Rice MM, Bailit JL, Grobman WA, Reddy UM, Wapner RJ, Thorp JM, Caritis SN, Prasad M, Tita AT, Saade GR, Sorokin Y, Rouse DJ, Blackwell SC, Tolosa JE; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-fetal Medicine Units Network. Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort. Am J Obstet Gynecol 2016; 215: 103.e1-14.
Costello JM, Polito A, Brown DW, McElrath TF, Graham DA, Thiagarajan RR, Bacha EA, Allan CK, Cohen JN, Laussen PC. Birth before 39 weeks' gestation is associated with worse outcomes in neonates with heart disease. Pediatrics 2010; 126: 277-284.
Sengupta S, Carrion V, Shelton J, Wynn RJ, Ryan RM, Singhal K, Lakshminrusimha S. Adverse neonatal outcomes associated with early-term birth. JAMA Pediatr 2013; 167: 1053-1059.
Mascarello KC, Horta BL, Silveira MF. Maternal complications and Cesarean section without indication: systematic review and meta-analysis. Rev Saude Publica 2017; 51: 105.
Jaeggi ET, Carvalho JS, De Groot E, Api O, Clur SA, Rammeloo L, McCrindle BW, Ryan G, Manlhiot C, Blom NA. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation 2011; 124: 1747-1754.
Morrison JJ, Rennie JM, Milton PJ. Neonatal respiratory morbidity and mode of delivery at term: Influence of timing of elective caesarean section. Br J Obstet Gynaecol 1995; 102: 101-106.
Engle WA, Kominiarek MA. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol 2008; 35: 325-341.
Boyle EM, Poulsen G, Field DJ, Kurinczuk JJ, Wolke D, Alfirevic Z, Quigley MA. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: Population based cohort study. BMJ 2012; 344: e896.
Hedges A, Corman H, Noonan K, Reichman NE. Gestational age at term and educational outcomes at age nine. Pediatrics 2021; 148: e2020021287.
Crump C, Sundquist J, Winkleby MA, Sundquist K. Gestational age at birth and mortality from infancy into mid-adulthood: a national cohort study. Lancet Child Adolesc Health 2019; 3: 408-417.
Young PC, Glasgow TS, Li X, Guest-Warnick G, Stoddard G. Mortality of late-preterm (near-term) newborns in Utah. Pediatrics 2007; 119: e659-665.
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: 849-856.
Johnson WH Jr, Dunnigan A, Fehr P, Benson DW Jr. Association of atrial flutter with orthodromic reciprocating fetal tachycardia. Am J Cardiol 1987; 59: 374-375.
Michel M, Renaud C, Chiu-Man C, Gross G, Jaeggi E. Postnatal recurrence and transesophageal inducibility of prenatally treated fetal supraventricular tachycardia. Heart Rhythm 2022; 19: 1343-1349.