Second-line treatment of fetal supraventricular tachycardia using flecainide acetate

Digoxin has been an effective treatment for fetal supraventricular tachycar dia (SVT), but second-line therapy remains more controversial. Thirty-seven cases of fetal SVT were identified that received digoxin as first-line the rapy. Seventeen fetuses (46%) converted to and maintained normal sinus rhyt hm . Flecainide was used in 13/15 patients requiring second-line therapy; 1 2/13 (92%) converted to sinus rhythm. Of seven hydropic fetuses, five requi red second-line therapy and were then successfully converted with flecainid e. The improved efficacy of flecainide was statistically significant with a p value <0.01. Complete follow-up was available in 13 digoxintreated and i n 12 second-line therapy infants. Prolonged or multiple drug therapy for po stnatal arrhythmia management was required in 3/13 (23%) patients in the di goxin group and in 8/12 (67%) patients requiring second-line therapy. This demonstrated a correlation between the need for second-line fetal therapy a nd more complex postnatal management with a p value of 0.003. Digoxin remai ns an effective first-line therapy in the treatment of fetal SVT. Flecainid e is an effective second-line therapy, especially in the face of fetal hydr ops. Use of second-line therapy in fetal SVT is a predictor of complex post natal course, and these patients should be followed more closely.