Frohn-Mulder I M, Stewart P A, Witsenburg M, Den Hollander N S, Wladimiroff J W, Hess J
Department of Pediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands.
Prenat Diagn. 1995 Dec;15(13):1297-302. doi: 10.1002/pd.1970151309.
Fetal supraventricular tachycardia (SVT) can be successfully treated transplacentally, but in cases where fetal hydrops develops there is considerable morbidity and mortality. The present study was carried out to establish whether the introduction of flecainide altered obstetric management and fetal outcome. A retrospective analysis took place of 51 singleton pregnancies which were referred to the division of prenatal diagnosis because of fetal tachycardia between 1982 and 1993. SVT was documented in 50 out of 51 fetuses, one of which displayed a combination of extensive rhabdomyomas and severe hydrops and died shortly after referral. In the other fetus ventricular tachycardia was diagnosed. Of the remaining 49 fetuses, 14 did not receive any prenatal treatment, but nine needed postnatal treatment. Transplacental treatment of SVT took place in 35 fetuses, of which 22 presented without hydrops and 13 with hydrops. These subsets differed significantly with respect to restoration of normal sinus rhythm (73% vs. 30%; p < 0.001) and mortality (0% vs. 46%; p < 0.001). Digoxin was effective in restoring sinus rhythm in 55 per cent of the non-hydropic fetuses but in only eight per cent of the hydropic fetuses. Flecainide was effective in restoring sinus rhythm in all non-hydropic fetuses where digoxin treatment failed, and in 43 per cent of hydropic fetuses. Administration of flecainide resulted in a significantly reduced mortality (p < 0.001) compared with digoxin treatment. No adverse effects were seen. Postnatal anti-arrhythmic treatment was necessary in 23 infants. Treatment could be withdrawn within one year in all cases but one.
胎儿室上性心动过速（SVT）可通过经胎盘治疗成功治愈，但在出现胎儿水肿的情况下，发病率和死亡率相当高。本研究旨在确定氟卡尼的引入是否改变了产科管理和胎儿结局。对1982年至1993年间因胎儿心动过速转诊至产前诊断科的51例单胎妊娠进行了回顾性分析。51例胎儿中有50例记录为室上性心动过速，其中1例合并广泛的横纹肌瘤和严重水肿，转诊后不久死亡。另一例胎儿被诊断为室性心动过速。其余49例胎儿中，14例未接受任何产前治疗，但9例需要产后治疗。35例胎儿接受了经胎盘治疗室上性心动过速，其中22例无水肿，13例有水肿。这些亚组在恢复正常窦性心律（73%对30%；p<0.001）和死亡率（0%对46%；p<0.001）方面有显著差异。地高辛在55%的非水肿胎儿中能有效恢复窦性心律，但在水肿胎儿中仅为8%。氟卡尼在所有地高辛治疗失败的非水肿胎儿以及43%的水肿胎儿中能有效恢复窦性心律。与地高辛治疗相比，氟卡尼的使用导致死亡率显著降低（p<0.001）。未观察到不良反应。23例婴儿需要产后抗心律失常治疗。除1例病例外，所有病例均可在1年内停药。
