Universität zu Köln

Strizek, Brigitte ORCID: 0000-0003-3625-7097, Berg, Christoph, Gottschalk, Ingo, Herberg, Ulrike ORCID: 0000-0002-9386-0258, Geipel, Annegret and Gembruch, Ulrich ORCID: 0000-0001-8284-4669 (2016). High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm, 13 (6). S. 1283 - 1289. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1556-3871

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Abstract

BACKGROUND Fetal tachyarrhythmia can lead to fetal hydrops due to heart failure. Recainide is often considered as second-line therapy when digoxin monotherapy fails, which is more likely in hydropic fetuses. Time to conversion to sinus rhythm (SR) is critical in cases presenting with hydrops. OBJECTIVE The aim of this study was to evaluate the efficacy and time to conversion to SR of transplacental treatment, especially flecainide. METHODS This is a retrospective observational study of 46 fetuses with fetal tachyarrhythmia. Treatment was either flecainide (n = 28, 60.9%), digoxin+flecainide combination (n = 4, 8.7%), or digoxin (n = 10, 21.7%). In 4 fetuses (8.7%), no treatment was necessary. RESULTS In our study population, 26 of the 32 fetuses (81.2%) that were treated with flecainide as a first-line therapy (flecainide or digoxin+flecainide) converted to SR. The median time to conversion to SR was 3 days (range 1-7 days) with flecainide monotherapy and 11.5 days (range 3-14 days) with a combination therapy. Seventy-two percent (13/18) of hydropic fetuses and 900/0 (9/10) of non hydropic fetuses converted to SR when treated with flecainide monotherapy. There was no statistical difference in rates of conversion to SR in hydropic and nonhydropic fetuses (P=.37) or time to conversion to SR in the 2 groups (P=.9). In the majority of the remaining fetuses, there was a partial response with decreased ventricular heart rates that were well tolerated. CONCLUSION Recainide is highly effective in achieving SR in hydropic and nonhydropic fetuses with supraventricular tachycardia in a median time of 3 days. In our opinion, flecainide should be considered as first-line therapy in fetal supraventricular tachycardia with and without hydrops.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Strizek, Brigitte UNSPECIFIED orcid.org/0000-0003-3625-7097 UNSPECIFIED Berg, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Gottschalk, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Herberg, Ulrike UNSPECIFIED orcid.org/0000-0002-9386-0258 UNSPECIFIED Geipel, Annegret UNSPECIFIED UNSPECIFIED UNSPECIFIED Gembruch, Ulrich UNSPECIFIED orcid.org/0000-0001-8284-4669 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-274044
DOI:	10.1016/j.hrthm.2016.01.029
Journal or Publication Title:	Heart Rhythm
Volume:	13
Number:	6
Page Range:	S. 1283 - 1289
Date:	2016
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1556-3871
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTRAUTERINE TREATMENT; TACHYARRHYTHMIAS; MANAGEMENT; DIAGNOSIS; DIGOXIN; DYSRHYTHMIAS; SOTALOL; FETUS Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27404