Strizek Brigitte, Berg Christoph, Gottschalk Ingo, Herberg Ulrike, Geipel Annegret, Gembruch Ulrich
Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany.
Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany; Division of Prenatal Medicine and Gynecologic Ultrasound, University of Cologne, Cologne, Germany.
Heart Rhythm. 2016 Jun;13(6):1283-8. doi: 10.1016/j.hrthm.2016.01.029. Epub 2016 Jan 29.
Fetal tachyarrhythmia can lead to fetal hydrops due to heart failure. Flecainide is often considered as second-line therapy when digoxin monotherapy fails, which is more likely in hydropic fetuses. Time to conversion to sinus rhythm (SR) is critical in cases presenting with hydrops.
The aim of this study was to evaluate the efficacy and time to conversion to SR of transplacental treatment, especially flecainide.
This is a retrospective observational study of 46 fetuses with fetal tachyarrhythmia. Treatment was either flecainide (n = 28, 60.9%), digoxin+flecainide combination (n = 4, 8.7%), or digoxin (n = 10, 21.7%). In 4 fetuses (8.7%), no treatment was necessary.
In our study population, 26 of the 32 fetuses (81.2%) that were treated with flecainide as a first-line therapy (flecainide or digoxin+flecainide) converted to SR. The median time to conversion to SR was 3 days (range 1-7 days) with flecainide monotherapy and 11.5 days (range 3-14 days) with a combination therapy. Seventy-two percent (13/18) of hydropic fetuses and 90% (9/10) of nonhydropic fetuses converted to SR when treated with flecainide monotherapy. There was no statistical difference in rates of conversion to SR in hydropic and nonhydropic fetuses (P = .37) or time to conversion to SR in the 2 groups (P = .9). In the majority of the remaining fetuses, there was a partial response with decreased ventricular heart rates that were well tolerated.
Flecainide is highly effective in achieving SR in hydropic and nonhydropic fetuses with supraventricular tachycardia in a median time of 3 days. In our opinion, flecainide should be considered as first-line therapy in fetal supraventricular tachycardia with and without hydrops.
胎儿心律失常可因心力衰竭导致胎儿水肿。当洋地黄单一疗法失败时，氟卡尼常被视为二线治疗药物，这种情况在水肿胎儿中更常见。对于出现水肿的病例，恢复窦性心律（SR）的时间至关重要。
本研究旨在评估经胎盘治疗，尤其是氟卡尼的疗效及恢复窦性心律的时间。
这是一项对46例胎儿心律失常胎儿的回顾性观察研究。治疗方法为氟卡尼（n = 28，60.9%）、洋地黄 + 氟卡尼联合治疗（n = 4，8.7%）或洋地黄（n = 10，21.7%）。4例胎儿（8.7%）无需治疗。
在我们的研究人群中，32例接受氟卡尼作为一线治疗（氟卡尼或洋地黄 + 氟卡尼）的胎儿中有26例（81.2%）恢复窦性心律。氟卡尼单一疗法恢复窦性心律的中位时间为3天（范围1 - 7天），联合治疗为11.5天（范围3 - 14天）。接受氟卡尼单一疗法治疗时，72%（13/18）的水肿胎儿和90%（9/10）的非水肿胎儿恢复窦性心律。水肿胎儿和非水肿胎儿恢复窦性心律的发生率（P = 0.37）或两组恢复窦性心律的时间（P = 0.9）无统计学差异。在大多数其余胎儿中，心室率降低有部分反应，且耐受性良好。
氟卡尼在使水肿和非水肿的室上性心动过速胎儿恢复窦性心律方面非常有效，中位时间为3天。我们认为，氟卡尼应被视为有或没有水肿的胎儿室上性心动过速的一线治疗药物。
