MANAGEMENT OUTCOME AND FOLLOW-UP OF FETAL TACHYCARDIA

Objectives. The aim of this study was to evaluate fetal tachycardia an d the efficacy of maternally administered antiarrhythmic agents and th e effect of this therapy on delivery and postpartum management Backgro und. Sustained fetal tachycardia is a potentially life-threatening con dition in which pharmacologic therapy is reported to be effective. The re is ongoing discussion about optimal management. Methods. A group of 51 patients with M-mode echocardiographically documented fetal tachyc ardia was studied retrospectively. Results. Thirty-three fetuses had s upraventricular tachycardia; 15 had atrial flutter; 1 had two episodes of both; and 2 had ventricular tachycardia. Fetal hydrops was seen in 22 patients. Thirty-four fetuses received maternal therapy with eithe r digoxin or flecainide as the first administered drug (additional dru gs were given in 12). Drug treatment was successful in establishing ac ceptable rhythm control in 82% (84% without, 80% with hydrops). In the latter group the median number of drugs and number of days to convers ion were higher. Three patients with fetal hydrops died. In 50% of cas es, tachycardia reappeared at delivery: 9 neonates presented with atri al flutter, 14 with supraventricular tachycardia and 1 with ventricula r tachyeardia. Seventy-eight percent of the group had pharmacologic th erapy by 1 month of age and 14% by 3 years. Conclusions. Fetal tachyca rdia can be treated adequately in the majority of patients, even in th e presence of hydrops, and therefore emergency delivery might not be i ndicated. Digoxin and flecainide were drugs of first choice and produc ed no serious adverse effects in this series of patients. The majority of patients not require prolonged therapy.