Abstract
Sustained fetal tachycardias are rare but represent a high risk of mortality and morbidity. Consensus has yet to be found regarding their optimal management. The aim of this narrative review is to summarize the data available in the current literature regarding the efficacy and safety of medications used in the management of intrauterine tachyarrhythmias and to provide possible treatment protocols. In this review, we would like to emphasize the importance of a thorough evaluation of both the fetus and the mother, prior to transplacental antiarrhythmic drug initiation. Factors such as the hemodynamic status of the fetus, possible mechanisms of fetal arrhythmia, and concomitant maternal conditions are of primordial importance. As a possible treatment protocol, we would like to recommend the following: due to the risk of sustained supraventricular tachycardia (SVT), fetuses with frequent premature atrial beats should be evaluated more frequently by echocardiography. A careful hemodynamic evaluation of a fetus with tachycardia is primordial in forestalling the appearance of hydrops. In the case of atrial flutter (AFL), sotalol therapy could represent a first choice, whereas when dealing with SVT patients, flecainide should be considered, especially for hydropic patients. These data require consolidation through larger scale, non-randomized studies and should be handled with caution.
Highlights
Fetal arrhythmias can occur in approximately 1% of pregnancies
atrial flutter (AFL) can occur secondary to myocarditis, structural congenital heart disease, or SSA autoantibodies [5].On the other hand, atrial fibrillation [6] and junctional ectopic tachycardia represent a rarity in this age group [7]
We reviewed data from the literature, from the first reports published regarding the management of fetal tachycardia to the most recent studies available
Summary
Fetal arrhythmias can occur in approximately 1% of pregnancies. The majority of these cardiac rhythm disorders are represented by benign conditions, such as premature atrial contractions, that do not require treatment [1]. AFL can occur secondary to myocarditis, structural congenital heart disease, or SSA autoantibodies [5].On the other hand, atrial fibrillation [6] and junctional ectopic tachycardia represent a rarity in this age group [7]. The latter is most often associated with the presence of SSA/Ro antibodies, with or without atrioventricular (AV) block [8,9]. Echocardiography (which remains the method of choice in the diagnostic process) does not allow a prolonged monitoring of the fetal rhythm [13] This deficiency may be one of the reasons for the progression of an undiagnosed tachyarrhythmia and the appearance of hydrops [14]. The aim of this narrative review is to summarize the data available in the current literature regarding the efficacy and safety of the antiarrhythmic medications used in the management of intrauterine tachyarrhythmias and to provide possible treatment protocols
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