The Lead Episode 63: A Discussion of Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias: Multicenter Trial

Discussion Topic: Antenatal Therapy for Fetal Supraventricular Tachyarrhythmias: Multicenter Trial

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by Aarti Dalal, DO, FHRS, CEPS-P, Vanderbilt University and Peter S. Fischbach, MA, MD, Emory University/Children’s Healthcare of Atlanta to discuss the multicenter, single-arm trial evaluated the safety and efficacy of transplacental treatment for fetal supraventricular tachycardia (SVT) and atrial flutter (AFL).

The treatment involved using digoxin, sotalol, and flecainide for singleton pregnancies from 22 to less than 37 weeks of gestation with sustained fetal SVT or AFL with heart rates of at least 180 beats per minute.Out of the 50 enrolled patients, fetal tachyarrhythmia resolved in 89.8% of cases overall, and in 75.0% of cases where fetal hydrops was present. Pre-term births occurred in 20.4% of patients.

Maternal adverse events were observed in 78.0% of patients, with serious adverse events leading to discontinuation of treatment in 4 patients. Two fetal deaths occurred due to heart failure, and neonatal tachyarrhythmia was observed in 31.9% of neonates within 2 weeks after birth. In conclusion, the transplacental treatment protocol was effective and tolerable in 90% of patients, but serious adverse events were noted in fetuses, and tachyarrhythmias could recur in neonates within the first 2 weeks after birth.

Host: Deepthy Varghese, MSN, ACNP, FNP
Guests: Aarti Dalal, DO, FHRS, CEPS-P and Peter S. Fischbach, MA, MD

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