Department of Obstetrics and Gynecology, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea.
Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Medicina (Kaunas). 2023 Jun 25;59(7):1198. doi: 10.3390/medicina59071198.
: Atrial flutter is an infrequent yet potentially fatal arrhythmia. Digoxin is the preferred first-line treatment for fetal atrial flutter due to its efficacy and favorable safety profile. The optimal digoxin serum target level for neonatal atrial flutter management remains uncertain, with the standard target level ranging from 1.0 to 2.0 ng/mL due to potential toxicity concerns above this threshold. : We present a case of atrial flutter in a fetus within a monochorionic diamniotic (MCDA) twin pregnancy that was successfully managed using a higher-than-standard target level of digoxin. A 34-year-old nulliparous woman was referred to our institution at 31 + 3 weeks of gestation due to fetal distress in an MCDA twin pregnancy. Fetal echocardiography revealed a ventricular rate of 214 bpm in twin A, while twin B exhibited no abnormal findings. : Our case highlights a distinct correlation between the serum digoxin level and its impact on atrial flutter. A higher target serum level of digoxin may be necessary to achieve sinus conversion due to the unique maternal and fetal circulatory characteristics in MCDA pregnancies.
心房扑动是一种不常见但潜在致命的心律失常。地高辛是胎儿心房扑动的首选一线治疗药物，因其疗效好且安全性良好。由于潜在的毒性问题，新生儿心房扑动管理的最佳地高辛血清靶目标水平仍不确定，标准靶目标水平范围为 1.0 至 2.0ng/mL。我们报告了一例在单绒毛膜双羊膜（MCDA）双胎妊娠中胎儿心房扑动的病例，该病例通过使用高于标准的地高辛靶目标水平成功得到管理。一名 34 岁的初产妇因 MCDA 双胎妊娠胎儿窘迫而被转诊至我院，在 31+3 周妊娠时。胎儿超声心动图显示胎儿 A 的心室率为 214 bpm，而胎儿 B 无异常发现。我们的病例突出了地高辛血清水平与其对心房扑动影响之间的明显相关性。由于 MCDA 妊娠中独特的母婴循环特征，可能需要更高的地高辛目标血清水平来实现窦性心律转换。
