HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by CUNEO, B. F. Articles by STRASBURGER, J. F. Search for Related Content PubMed PubMed Citation Articles by CUNEO, B. F. Articles by STRASBURGER, J. F.

Management Strategy for Fetal Tachycardia

From The Heart Institute for Children, Department of Pediatrics, Hope Children’s Hospital, Oak Lawn, Illinois; and the Section of Cardiology, Department of Pediatrics, Children’s Memorial Hospital, Northwestern University Medical School, Chicago, Illinois.

Address reprint requests to: Janette F. Strasberger, MD Children’s Memorial Hospital 2300 Children’s Plaza, Box 21 Chicago, IL 60614

Objective: To develop a management strategy for fetal tachycardia.

Methods: Forty-four fetuses (20–40 weeks’ gestation) with nonsinus tachycardia were divided into three groups based on duration of tachycardia and degree of heart failure. Fetuses with intermittent tachycardia were treated expectantly. Fetuses with sustained tachycardia were treated with transplacental antiarrhythmic agents alone if heart failure was mild to moderate, and with direct intramuscular therapy if heart failure was severe. Degree of heart failure was determined by echocardiographic variables of ventricular function, atrioventricular valve insufficiency, and hydrops. Fetal well-being and response to treatment were evaluated by daily heart rate surveillance and frequent fetal echocardiograms and ultrasounds.

Results: Fifteen fetuses with intermittent tachycardia (n = 15, group 1) did not progress to sustained tachycardia or heart failure. Fetuses with sustained tachycardia and mild-to-moderate heart failure (n = 14, group 2) were cardioverted or rate controlled with transplacental agents (n = 9); three term fetuses were delivered electively without treatment and two progressed to severe heart failure and were treated in group 3. Seventeen fetuses (15 initially, two progressing) with severe heart failure were cardioverted (in 0.25–21 days; mean 4.3 days) with fetal intramuscular plus transplacental antiarrhythmic therapy (group 3). Overall, 43 of 44 fetuses were delivered at 32 to 41 (mean 37) weeks with minimal morbidity and a mortality rate of 2.2% (95% confidence interval 0.06%, 12.0%).

Conclusion: Perinatal mortality and morbidity were low after following a management strategy based on duration of tachycardia, degree of heart failure, and biophysical profile combined with vigilant ongoing fetal surveillance.

This article has been cited by other articles:

				H. R. Singh, S. Garekar, M. L. Epstein, and T. L'Ecuyer Neonatal Supraventricular Tachycardia (SVT) NeoReviews, July 1, 2005; 6(7): e339 - e350. [Full Text] [PDF]

				M. A. Oudijk, J. M. Ruskamp, F. F. T. Ververs, E. B. Ambachtsheer, P. Stoutenbeek, G. H. A. Visser, and E. J. Meijboom Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics J. Am. Coll. Cardiol., August 20, 2003; 42(4): 765 - 770. [Abstract] [Full Text] [PDF]