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Chapter 17 - Fetal Supraventricular Tachyarrhythmias: Pharmacokinetics, Modes of Action, and Results of Anti-Arrhythmic Drug Therapy

from Fetal Dysrhythmias

Published online by Cambridge University Press:  21 October 2019

By
Edgar Jaeggi  and
Nico A. Blom
Edited by
Mark D. Kilby ,
Anthony Johnson  and
Dick Oepkes
Mark D. Kilby
Affiliation:
University of Birmingham
Anthony Johnson
Affiliation:
University of Texas Medical School at Houston
Dick Oepkes
Affiliation:
Leids Universitair Medisch Centrum
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Summary

Supraventricular tachycardia (SVT) belongs to the common cardiac causes of fetal heart failure and perinatal death [1]. With the arrival of ultrasound imaging to non-invasively detect cardiac anomalies before birth, the fetus has increasingly become the target of intended prenatal treatment. This includes the off-label administration of pharmaceutical agents via the maternal circulation or directly into the fetus to treat SVT. As anti-arrhythmic drugs act on one or several ion channels, the autonomous system, or both, we will start with an overview of the normal and abnormal electro-mechanical activation of the heart before discussing indications, modes of action, and effects of anti-arrhythmic therapy for fetal SVT.

Type
Chapter
Information
Fetal Therapy
Scientific Basis and Critical Appraisal of Clinical Benefits
 , pp. 166 - 175
Publisher: Cambridge University Press
Print publication year: 2020

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References

Naheed, ZJ, Strasburger, JF, Deal, BJ, Benson, DW Jr., Gidding, SS. Fetal tachycardia: mechanisms and predictors of hydrops fetalis. J Am Coll Cardiol. 1996; 27: 1736–40.CrossRefGoogle ScholarPubMed
Artman, M, Coetzee, W. Developmental regulation of cardiac ion channels. In Zipes, D, Jalife, J, eds., Cardiac Electrophysiology: From Cell to Bedside. Philadelphia, PA: Saunders Elsevier, 2009, pp. 157–68.Google Scholar
Creazzo, T. Functional developmental biology of the myocardium. In Loewy Kirby, M, ed., Cardiac Development. New York: Oxford University Press, 2007, pp. 53–68.Google Scholar
Friedman, WF. The intrinsic physiologic properties of the developing heart. Prog Cardiovasc Dis. 1972; 15: 87–111.CrossRefGoogle ScholarPubMed
Romero, T, Covell, J, Friedman, WF. A comparison of pressure-volume relations of the fetal, newborn, and adult heart. Am J Physiol. 1972; 222: 1285–90.Google Scholar
Schmidt, MR, Kristiansen, SB, White, P, Smerup, M, Bøtker, HE, Vogel, M, Hjortdal, V, Sørensen, K, Redington, A. Glucose-insulin infusion improves cardiac function during fetal tachycardia. J Am Coll Cardiol. 2004; 43: 445–52.Google Scholar
Vanoli, E, Cerati, D, Pedretti, RF. Autonomic control of heart rate: pharmacological and nonpharmacological modulation. Basic Res Cardiol. 1998; 93 (Suppl. 1): 133–42.Google Scholar
Rudolph, AM, Heymann, MA. Cardiac output in the fetal lamb: the effects of spontaneous and induced changes of heart rate on right and left ventricular output. Am J Obstet Gynecol. 1976; 124: 183–92.Google Scholar
Reed, KL, Appleton, CP, Anderson, CF, Shenker, L, Sahn, DJ. Doppler studies of vena cava flows in human fetuses. Insights into normal and abnormal cardiac physiology. Circulation. 1990; 81: 498–505.CrossRefGoogle ScholarPubMed
Brace, RA. Effects of outflow pressure on fetal lymph flow. Am J Obstet Gynecol. 1989; 160: 494–7.CrossRefGoogle ScholarPubMed
Rudolph, A. The fetal circulation and postnatal adaptation. In Rudolph, A, ed., Congenital Diseases of the Heart. Armonk, NY: Future Publishing Company, 2001, pp. 3–44Google Scholar
Schmidt, KG, Ulmer, HE, Silverman, NH, Kleinman, CS, Copel, JA. Perinatal outcome of fetal complete atrioventricular block: a multicenter experience. J Am Coll Cardiol. 1991; 17: 1360–6.Google Scholar
Simpson, JM, Sharland, GK. Fetal tachycardias: management and outcome of 127 consecutive cases. Heart. 1998; 79: 576–81.Google Scholar
Jaeggi, E, Fouron, JC, Drblik, SP. Fetal atrial flutter: diagnosis, clinical features, treatment, and outcome. J Pediatr. 1998; 132: 335–9.Google Scholar
Jaeggi, ET, Carvalho, JS, De Groot, E, Api, O, Clur, SA, Rammeloo, L, McCrindle BW, , Ryan, G, Manlhiot, C, Blom, NA. Comparison of transplacental treatment of fetal supraventricular tachyarrhythmias with digoxin, flecainide, and sotalol: results of a nonrandomized multicenter study. Circulation. 2011; 124: 1747–54.Google Scholar
Wacker-Gussmann, A, Strasburger, JF, Srinivasan, S, Cuneo, BF, Lutter, W, Wakai, RT. Fetal atrial flutter: electrophysiology and associations with rhythms involving an accessory pathway. J Am Heart Assoc. 2016; 5: e003673.Google Scholar
Kleinman, CS, Donnerstein, RL, Jaffe, CC, DeVore, GR, Weinstein, EM, Lynch, DC, Talner, NS, Berkowitz, RL, Hobbins, JC. Fetal echocardiography. A tool for evaluation of in utero cardiac arrhythmias and monitoring of in utero therapy: analysis of 71 patients. Am J Cardiol. 1983; 51: 237–43.Google Scholar
Jaeggi, E, Fouron, JC, Fournier, A, van Doesburg, N, Drblik, SP, Proulx, F. Ventriculo-atrial time interval measured on M mode echocardiography: a determining element in diagnosis, treatment, and prognosis of fetal supraventricular tachycardia. Heart. 1998; 79: 582–7.Google Scholar
Fouron, JC, Fournier, A, Proulx, F, Lamarche, J, Bigras, JL, Boutin, C, Brassard, M, Gamache, S. Management of fetal tachyarrhythmia based on superior vena cava/aorta Doppler flow recordings. Heart. 2003; 89: 1211–16.Google Scholar
Donofrio, MT, Moon-Grady, AJ, Hornberger, LK, Copel, JA, Sklansky, MS, Abuhamad, A, et al. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014; 129: 2183–242.CrossRefGoogle ScholarPubMed
Kleinman, CS, Copel, JA, Weinstein, EM, Santulli, TV Jr., Hobbins, JC. Treatment of fetal supraventricular tachyarrhythmias. J Clin Ultrasound. 1985; 13: 265–73.Google Scholar
van Engelen, AD, Weijtens, O, Brenner, JI, Kleinman, CS, Copel, JA, Stoutenbeek, P, Meijboom, EJ. Management outcome and follow-up of fetal tachycardia. J Am Coll Cardiol. 1994; 24: 1371–5.Google Scholar
Frohn-Mulder, IM, Stewart, PA, Witsenburg, M, Den Hollander, NS, Wladimiroff, JW, Hess, J. The efficacy of flecainide versus digoxin in the management of fetal supraventricular tachycardia. Prenat Diagn. 1995; 15: 1297–302.Google Scholar
Ebenroth, ES, Cordes, TM, Darragh, RK. Second-line treatment of fetal supraventricular tachycardia using flecainide acetate. Pediatr Cardiol. 2001; 22: 483–7.Google Scholar
Jouannic, JM, Delahaye, S, Fermont, L, Le Bidois, J, Villain, E, Dumez, Y, Dommerques, M. Fetal supraventricular tachycardia: a role for amiodarone as second-line therapy? Prenat Diagn. 2003; 23: 152–6.Google Scholar
Sridharan, S, Sullivan, I, Tomek, V, Wolfenden, J, Škovranek, J, Yates, R, Janoušek, J, Dominguez, TE, Marek, J. Flecainide versus digoxin for fetal supraventricular tachycardia: comparison of two drug treatment protocols. Heart Rhythm. 2016; 13: 1913–19.CrossRefGoogle ScholarPubMed
Ekman-Joelsson, BM, Mellander, M, Lagnefeldt, L, Sonesson, SE. Foetal tachyarrhythmia treatment remains challenging even if the vast majority of cases have a favourable outcome. Acta Paediatr. 2015; 104: 1090–7.Google Scholar
Hill, GD, Kovach, JR, Saudek, DE, Singh, AK, Wehrheim, K, Frommelt, MA. Transplacental treatment of fetal tachycardia: a systematic review and meta-analysis. Prenat Diagn. 2017; 37: 1076–83.Google Scholar
Allan, LD, Chita, SK, Sharland, GK, Maxwell, D, Priestley, K. Flecainide in the treatment of fetal tachycardias. Br Heart J. 1991; 65: 46–8.Google Scholar
Barjot, P, Hamel, P, Calmelet, P, Maragnes, P, Herlicoviez, M. Flecainide against fetal supraventricular tachycardia complicated by hydrops fetalis. Acta Obstet Gynecol Scand. 1998; 77: 353–8.Google ScholarPubMed
Strizek, B, Berg, C, Gottschalk, I, Herberg, U, Geipel, A, Gembruch, U. High-dose flecainide is the most effective treatment of fetal supraventricular tachycardia. Heart Rhythm. 2016; 13: 1283–8.Google Scholar
Ekiz, A, Kaya, B, Bornaun, H, Acar, DK, Avci, ME, Bestel, A, Yildirim, G. Flecainide as first-line treatment for fetal supraventricular tachycardia. J Matern Fetal Neonatal Med. 2018: 31: 407–12.Google Scholar
Sonesson, SE, Fouron, JC, Wesslen-Eriksson, E, Jaeggi, E, Winberg, P. Foetal supraventricular tachycardia treated with sotalol. Acta Paediatr. 1998; 87: 584–7.CrossRefGoogle ScholarPubMed
Oudijk, MA, Michon, MM, Kleinman, CS, Kapusta, L, Stoutenbeek, P, Visser, GH, Meijboom, EJ. Sotalol in the treatment of fetal dysrhythmias. Circulation. 2000; 101: 2721–6.Google Scholar
Oudijk, MA, Ruskamp, JM, Ververs, FF, Ambachtsheer, EB, Stoutenbeek, P, Visser, GH, Meijboom, EJ. Treatment of fetal tachycardia with sotalol: transplacental pharmacokinetics and pharmacodynamics. J Am Coll Cardiol. 2003; 42: 765–70.CrossRefGoogle ScholarPubMed
Shah, A, Moon-Grady, A, Bhogal, N, Collins, KK, Tacy, T, Brook, M, Hornberger, LK. Effectiveness of sotalol as first-line therapy for fetal supraventricular tachyarrhythmias. Am J Cardiol. 2012; 109: 1614–18.CrossRefGoogle ScholarPubMed
van der Heijden, LB, Oudijk, MA, Manten, GT, ter Heide, H, Pistorius, L, Freund, MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. Ultrasound Obstet Gynecol. 2013; 42: 285–93.CrossRefGoogle ScholarPubMed
Uzun, O, Babaoglu, K, Sinha, A, Massias, S, Beattie, B. Rapid control of foetal supraventricular tachycardia with digoxin and flecainide combination treatment. Cardiol Young. 2012; 22: 372–80.Google ScholarPubMed
Strasburger, JF, Cuneo, BF, Michon, MM, Gotteiner, NL, Deal, BJ, McGregor, SN, Oudijk, MA, Meijboom, EJ, Feinkind, L, Hussey, M, Parilla, BV. Amiodarone therapy for drug-refractory fetal tachycardia. Circulation. 2004; 109: 375–9.CrossRefGoogle ScholarPubMed
Krapp, M, Baschat, AA, Gembruch, U, Geipel, A, Germer, U. Flecainide in the intrauterine treatment of fetal supraventricular tachycardia. Ultrasound Obstet Gynecol. 2002; 19: 158–64.Google Scholar
Hansmann, M, Gembruch, U, Bald, R, Manz, M, Redel, DA. Fetal tachyarrhythmias: transplacental and direct treatment of the fetus – a report of 60 cases. Ultrasound Obstet Gynecol. 1991; 1: 162–8.Google Scholar
Parilla, BV, Strasburger, JF, Socol, ML. Fetal supraventricular tachycardia complicated by hydrops fetalis: a role for direct fetal intramuscular therapy. Am J Perinatol. 1996; 13: 483–6.CrossRefGoogle ScholarPubMed
Moatassim, S, Touleimat, S, Hazelzet, T, Brasseur, MD, Diguet, A, Durand, I, Verspyck, E. Maternal complications induced by digoxin treatment of fetal tachycardia: a retrospective series of 18 cases. J Gynecol Obstet Hum Reprod. 2018; 47: 35–8.Google Scholar
Bourget, P, Pons, JC, Delouis, C, Fermont, L, Frydman, R. Flecainide distribution, transplacental passage, and accumulation in the amniotic fluid during the third trimester of pregnancy. Ann Pharmacother. 1994; 28: 1031–4.Google Scholar
Hopson, JR, Buxton, AE, Rinkenberger, RL, Nademanee, K, Heilman, JM, Kienzle, MG. Safety and utility of flecainide acetate in the routine care of patients with supraventricular tachyarrhythmias: results of a multicenter trial. The Flecainide Supraventricular Tachycardia Study Group. Am J Cardiol. 1996; 77: 72A–82A.Google Scholar
Hohnloser, SH, Woosley, RL. Sotalol. N Engl J Med. 1994; 331: 31–8.Google Scholar
Peralta, AO, John, RM, Gaasch, WH, Taggart, PI, Martin, DT, Venditti, FJ. The class III antiarrhythmic effect of sotalol exerts a reverse use-dependent positive inotropic effect in the intact canine heart. J Am Coll Cardiol. 2000; 36: 1404–10.Google Scholar
Arnoux, P, Seyral, P, Llurens, M, Djiane, P, Potier, A, Unal, D, Cano, JP, Serradimigni, A, Rouault, F. Amiodarone and digoxin for refractory fetal tachycardia. Am J Cardiol. 1987; 59: 166–7.Google Scholar
Gembruch, U, Manz, M, Bald, R, Rüddel, H, Redel, DA, Schlebusch, H, Nitsch, J, Hansmann, M. Repeated intravascular treatment with amiodarone in a fetus with refractory supraventricular tachycardia and hydrops fetalis. Am Heart J. 1989; 118: 1335–8.Google Scholar
Bartalena, L, Bogazzi, F, Braverman, LE, Martino, E. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest. 2001; 24: 116–30.Google Scholar
Magee, LA, Nulman, I, Rovet, JF, Koren, G. Neurodevelopment after in utero amiodarone exposure. Neurotoxicol Teratol. 1999; 21: 261–5.CrossRefGoogle ScholarPubMed
Vanbesien, J, Casteels, A, Bougatef, A, De Catte, L, Foulon, W, De Bock, S, Smitz, J, De Schepper, J. Transient fetal hypothyroidism due to direct fetal administration of amiodarone for drug resistant fetal tachycardia. Am J Perinatol. 2001; 18: 113–16.Google Scholar
Gembruch, U, Hansmann, M, Redel, DA, Bald, R. Intrauterine therapy of fetal tachyarrhythmias: intraperitoneal administration of antiarrhythmic drugs to the fetus in fetal tachyarrhythmias with severe hydrops fetalis. J Perinat Med. 1988; 16: 39–44.Google Scholar
Gembruch, U, Manz, M, Bald, R, Ruddel, H, Redel, DA, Schlebusch, H, Nitsch, J, Hansmann, M. Repeated intravascular treatment with amiodarone in a fetus with refractory supraventricular tachycardia and hydrops fetalis. Am Heart J. 1989; 118: 1335–8.CrossRefGoogle Scholar

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