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The Use of Flecainide...
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The Use of Flecainide in the Treatment of Fetal Supraventricular Tachycardia Eric S. Ebenroth, Timothy M. Cordes, Robert K. Darragh, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN Background: Fetal supraventricular tachycardia (SVT) is a common reason for referral for fetal cardiac evaluation. Digoxin has been widely demonstrated as a safe and effective treatment for fetal SVT. Second line therapy, however, remains more controversial. Methods: This study evaluated the efficacy of maternal flecainide as second line therapy in the treatment of fetal SVT. The charts of women referred to Indiana University Hospitals for fetal echocardiography were reviewed. Forty cases were identified from August 1988 to July 1999. Results: Thirty-seven patients received digoxin as first line therapy, while three were delivered outright. Seventeen fetuses (46%) converted and maintained sinus rhythm until delivery. Flecainide was used in 13/15 patients who required second line therapy converting the SVT to sinus rhythm in 12/13 (92%). Six of eight patients with fetal hydrops failed to convert on digoxin alone. Four of these hydropic fetuses were then treated with flecainide and successfully converted. The improved efficacy of flecainide as compared to digoxin alone in conversion of fetal SVT was statistically significant with a p value < 0.05. Complete follow up was available in 13 digoxin treated infants and in 10 of the infants requiring second line therapy. Prolonged and/or multiple drug therapy for postnatal arrhythmia management was required in 3/13 (23%) patients in the digoxin group and in 6/10 (60%) patients requiring second line therapy. Although this was suggestive of a correlation between complex disease and need for second line fetal therapy, it was not statistically significant with a p value of 0.10. Conclusions: Digoxin remains a safe and effective first line therapy in the treatment of fetal SVT. Flecainide is a very effective second line therapy, especially in the face of fetal hydrops. With appropriate management, it should be possible to convert nearly any fetus, including those with hydrops fetalis, to a stable rhythm and deliver at or near term. Use of second line therapy in fetal SVT may also be a predictor of more complex postnatal course and these patients should be followed more closely. Published in abstract form in The Journal of the American College of Cardiology. 35(2) Supplement A: 518A, 2000 Feb. Presented at the Annual American College of Cardiology Meeting, March 2000, Anaheim. In press for publication in Pediatric Cardiology by the middle to end of 2000. |
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