EP24.06: Transplacental and direct fetal therapy for tachyarrhythmias

In utero management and perinatal outcome in 5 cases of fetal tachyarrhythmias with structurally normal hearts. Case 1: Diagnosed supraventricular tachycardia (SVT) at 22 weeks. Reverted to sinus rhythm in 12 hrs, with flecainamide. Deliverd at term, baby had sinus rhythum. Case 2: G4 previous 2 pregnancies with hydrops. NIPT and anomaly scan normal. Developed pleural effusion at 29 weeks. A week later developed atrial flutter, treated successfully with transplacental digoxin, pleural effusion resolved, currently 36 weeks Case 3: Diagnosed at 32 weeks with SVT, received oral flecainamide and digoxin with no response, referred to us for fetal digoxin. No response over next 48hrs, flecainamide was stopped and sotolol added. In view of no response and poor myocardial function, delivered at 32+5 weeks. Postnatally diagnosed ectopic atrial tachycardia with left ventricular dysfunction. Refractory to treatment, died at 24 hrs of life. Case 4: SVT at 31 weeks, started on transplacental flecainamide, digoxin added. Still had SVT, received fetal IM digoxin at 90ug/kg given twice, with short lasting response. In view of inadequate control, flecainamide replaced with sotolol. Fetus developed atrial bigeminy, gradually sotolol and digoxin were stopped. Delivered by CS at 36 weeks. Postdelivery a diagnosis of sick sinus with atrial ectopics with intermittent SVT was kept. Heart rate at birth was 80-90bpm, did not require any treatment. On follow up at 4 weeks HR is 120/mt. Case 5: Diagnosed SVT at 35 weeks, treated with maternal digoxin, sotalol and fetal digoxin therapy. Rate controlled, delivered at 36 weeks, at birth atrial flutter managed with cardioversion, digoxin, metaprolol and amiadarone. Discharged on propranolol and digoxin. This case series highlights that treatment needs to be individualised. Role of direct fetal therapy is limited. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.