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Favourable outcome for hydrops or cardiac failure associated with fetal tachyarrhythmia: a 20-year review

Part of: Echocardiography

Published online by Cambridge University Press:  23 September 2021

Gulhan Tunca Sahin Open the ORCID record for Gulhan Tunca Sahin [Opens in a new window] ,
Robert Bryan Beattie  and
Orhan Uzun
Gulhan Tunca Sahin
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
Robert Bryan Beattie
Affiliation:
Department of Fetal Medicine, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK
Orhan Uzun*
Affiliation:
Department of Paediatric Cardiology, University Hospital of Wales, Wales, Cardiff CF14 4XW, UK
*
Author for correspondence: Prof. O. Uzun, Department of Pediatric Cardiology, University Hospital of Wales, Heath Park, Wales, Cardiff CF14 4XW, UK. Tel: +442920 744743; Fax: +44 2920 744745. E-mail: [email protected]
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Abstract

Background:

Prognosis of fetuses with hydrops and tachyarrhythmia has been portrayed as poor in most published reports. This might lead to biased counselling, unnecessary caesarean section, preterm delivery, and even termination of pregnancy.

Aims:

To evaluate contemporary fetal and postnatal outcomes of hydropic fetuses with fetal tachyarrhythmia when it is treated effectively and monitored systematically.

Methods:

This is a retrospective review of a single centre experience at the University Hospital of Wales over a 20-year period. All fetuses received high doses of flecainide and digoxin combination treatment. Tachycardia response rate, time to arrhythmia and hydrops resolution, fetal and postnatal morbidity, and mortality rates were analysed.

Results:

Twenty fetuses were diagnosed with hydrops fetalis and received treatment. The mechanism of fetal tachyarrhythmia was supraventricular tachycardia in thirteen and atrial flutter in eight cases. Among the 20 fetuses treated, the overall tachycardia response rate was 90% (18/20) with the restoration of sinus rhythm in 85% (17/20) of the cases. The median time to restore sinus rhythm or to rate control of the arrhythmia was 1.5 days (range 12 hours to 13 days). Hydrops resolved in 17 of the 20 fetuses, with a median time of 12 days (range 3–21 days). Four fetuses went into spontaneous preterm birth and one fetus was delivered early due to worsening hydrops. No significant neurological morbidity was observed in surviving neonates and infants on clinical examination. There was one postnatal death due to respiratory complications of prematurity in the non-responsive supraventricular tachycardia case.

Conclusions:

High-dose flecainide and digoxin combination offers effective treatment strategy in fetuses with hydrops and tachyarrhythmia with favourable outcomes. This study may guide more realistic counselling for pregnancies complicated by tachyarrhythmia and hydrops.

Keywords

Hydrops fetalisfetaltachyarrhythmiacardiac failuredigoxinflecainide
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 7 , July 2022 , pp. 1077 - 1084
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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