Problems of therapy of fetal life-threatening dysrhythmias

Fetal supraventricular tachycardia acid atrial flutter are life-threatening dysrhythmias, which, untreated, may ca use non-immune fetal hydrops and ma y lead to fetal death. In the literature optimal management and the way of antiarrhythmic maternal and more recently fetal drug therapy remains contro versial. The aim of this article is to report on the problems of thera py o f feta I tachyarrhythmias and to summarize current knowledge. After diagnos ing the arrhythmia with the help of M mode or doppler echocardiography peri natologists, neonatologists and pediatric cardiologists have to decide on t he further proceedings individually. The fetus without signs of hydrops can often be treated successfully with digoxin administered to the mother. In fetuses with tachycardia-induced hydrops digoxin is the drug of first choic e, too. They, however, need significantly mo re antiarrhythmic drugs and lo nger therapy for cardioversion into sinusrhythm, which is achieved less fre quently than in fetuses with out hydrops. In hydrops patients a further opt ion is direct fetal therapy with drug application into the umbilical vein. Longterm prognosis seems to be excellent regardless of the severity of illn ess at clinical presentation.