[Fetal supraventricular tachycardia].

BACKGROUND

Fetal supraventricular tachycardia is an infrequent and difficult to manage disease. Several therapeutic approaches have been proposed. We report our experience in its diagnosis and management.

OBJECTIVES

Evaluation of the clinical features of fetal supraventricular tachycardia and efficacy of maternal and fetal medications in use for treatment. Immediate neonatal evolution is commented on. A therapeutic schema is proposed.

PATIENTS: Nineteen fetuses with echocardiographically (M-mode and/or Doppler two dimensionally oriented) supraventricular tachycardia were diagnosed.

RESULTS

Mean gestational age was 32 weeks; 8 fetuses had developed hydrops; 3 patients had dilated cardiomyopathy (two of them were hydropic). Two cases were prenatally diagnosed as atrial flutter (both of them without hydrops). Sixteen fetuses received transplacentary treatment: 8 with digital, 6 more associated with flecainide, direct administration of amiodarone to the fetus was added in two cases. Three patients died during follow-up (one postnatally, at third week of life), all of them had developed hydrops; arrhythmia characteristics were unmodified in three and control of cardiac rhythm was achieved in ten cases.

CONCLUSIONS

In the majority of cases there are no cardiac malformations associated. It is possible to control the tachycardia, even if hydrops is present. It is not indicated to abbreviate the gestation. First election drugs are maternal digoxin and flecainide, they do not produce significant fetal or maternal secondary effects. Occasionally it is necessary to add or to change to other drugs or to propose more aggressive approaches.