EC Paediatrics

Supraventricular tachycardia is the most common fetal tachyarrhythmia and if persistent often associated with fetal hydrops which can cause intrauterine and neonatal death. The management varies with each center and is typically based on published case series, institutional experience, gestational age at presentation, the presence and degree of fetal compromise, hydrops or other risk factors, maternal condition, and potential maternal risk from both fetal therapy and early delivery (post-natal therapy). The first case was fetal supraventricular tachycardia (SVT) detected at 30 weeks gestational age (GA). Patient was treated by transplacental digoxin therapy for 10 days with no result. We perform direct fetal intramuscular with amiodarone and then digoxin, which resulted in conversion to sinus rhythm sustained only for two days. We decided to perform early delivery and proceed to post-natal treatment. The result of ECG on perinatal period was WPW pattern or preexcitation consists of a short PR interval and prolonged QRS with an initial slurring upstroke (“delta” wave) in the presence of sinus rhythm. WPW syndrome reverted to normal after propranolol and amiodarone combination therapy. On 4 months of age the patient only received amiodarone and the ECG show normal sinus rhythm with normal growth and development.

 Keyword: Neonatal; Fetal Supraventricular Tachycardia; WPW Syndrome

1. Çetin C., et al. “Successful medical treatment of fetal supraventricular tachycardia that cause hydrops fetalis”. Turkish Journal of Obstetrics and Gynecology 3 (2014): 193-195.
2. Trisha Vigneswaran and John Simpson. “Fetal arrhythmia’s in: Fetal cardiology: A practical approach to diagnosis and management”. Springer Nature (2018).
3. Malhamé I., et al. “Maternal monitoring and safety considerations during antiarrhythmic treatment for fetal supraventricular tachycardia”. Obstetric Medicine 2 (2019): 66-75.
4. Kang S-L., et al. “Foetal supraventricular tachycardia with hydrops fetalis: a role for direct intraperitoneal amiodarone”. Cardiology in the Young3 (2015): 447-453.
5. Alina V., et al. “Treatment of fetal arrhythmias”. Journal of Clinical Medicine11 (2021): 2510.
6. Edgar Jaeggi and Nico A Blom. “Fetal SVT in: Fetal therapy: Scientific basis and critical appraisal of clinical benefits”. Cambridge University Press (2020).
7. Afshar MM., et al. “WPW syndrome: Review of the evidence”. Novel Approaches in Drug Designing and Development 1 (2021): 555679.